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SHORT TALKS 
WITH YOUNG MOTHERS 

ON THE MANAGEMENT OF INFANTS 
AND YOUNG CHILDREN 



BY 

Charles Gilmore Kerley, M.D. 

Formerly Professor of Diseases of Children, New York Polyclinic Medical 
School and Hospital ; Attending Physician to the New York Nursery 
and Child's Hospital ; Consulting Physician to the Babies' Hospital, 
New York ; Consulting Physician, New York Home for Crippled 
and Destitute Children; Consulting Pediatrist, Greenwich Hospi- 
tal ; Consulting Pediatrist, Savilla Home, N. Y.; Consulting 
Pediatrist, Volunteer Hospital, N. Y., Consulting Pediatrist 
of the Tarry town Hospital, Englewood Hospital and 
Lawrence Hospital, Bronxville, N. Y. 



SEVENTH EDITION, REVISED 

ILLUSTRATED 



G. P. PUTNAM'S SONS 

NEW YORK AND LONDON 

Zbe Umicfcerbocfcer jpress 






a* 



Copyright, 1922 

by 

Charles Gilmore Kerley 



Made in the United States of America 




APR 26 1922 



©1A659768 









TO 

L. EMMETT HOLT, M.D., LL.D. 
THIS WORK IS INSCRIBED 

IN RECOGNITION OF HIS HIGH PROFESSIONAL ATTAINMENTS AND 

ENTHUSIASM IN PROMOTING THE STUDY OF DISEASES 

OF CHILDREN, AND IN GRATEFUL APPRECIATION 

OF MANY ACTS OF KINDNESS 



PREFACE TO SEVENTH EDITION 

THE aim of this book is to help the 
young mother to a closer acquaint- 
ance with and a more intelligent apprecia- 
tion of the nature and demands of the 
little life entrusted to her care. 

In its preparation the author has kept 
in mind and has endeavored to answer 
the personal questions of many thought- 
ful young mothers. Under management are 
given such suggestions as may be carried out 
by the mother or nurse and in no way do 
away with the necessity of a physician. 

Suggestions relating to medical treat- 
ment are intentionally avoided. A mother 
should know all the details of the child's 
feeding, clothing, bathing, and airing, and 
what to do in an emergency. She should 
also be able to recognize symptoms of ill- 
ness and appreciate their significance. She 
is not supposed to be skilled in the use 
of drugs. 

v 



CONTENTS 



Adenoids 
Appetite 
Artificial bottle-feeding 

Baskets for early exercise 
Baths .... 

The cold douche 

Tub-baths for fever 

Basin bathing for fever 

Bathing for comfort in hot weather 

Mustard bath 

Brine bath 

Soda bath 

Bran bath 

Starch bath 

Hot bath 
Bed-wetting 
Bites of animals 
Bites of insects 
Boils . 
Bronchitis 
Burns . 

Care of the breasts and nipples 
Care of the genitals 

Painful micturition, circumcision 



PAGE 

131 

136 

6O 

302 
III 

112 
114 
114 
114 
115 
115 
116 
116 
116 
116 
27O 
292 
292 
236 
I64 
292 

48 
273 
273 



viii Contents 








PAGE 


Chicken-pox ..... 


I8 7 


Children's parties 




. 302 


Cleanliness . 




286 


Clothing to be provided 




3 


Cold hands and feet 




287 


Cold in the head (coryza) 




• 163 


Colic .... 




256 


Condensed milk 




83 


Constipation 




261 


Management in the breast-fed . 


262 


Management in the bottJe-fed . 


264 


Management in older children 


265 


Contagious diseases 


174 


Convulsions .... 


253 


Cooking of vegetables 


81 


Cough ...... 


157 


Chronic cough 


158 


Croup — catarrhal, diphtheritic 


167 


Crying 


284 


Cuts, bruises, and sprains 


291 


Dentition ..... 


120 


The breast-fed 


120 


The well-managed bottle-fed 


121 


The badly fed 


121 


Diet from the first to the eleventh year 


73 


Diet during illness 


94 


The art of feeding in illness 


96 


Diphtheria . ... 




184 



Contents 


ix 




PAGE 


Disinfection after contagious diseases- 




fumigation 


195 


Don'ts ..... 


311 


Drug-giving 


299 


Earache ..... 


117 


Eczema ..... 


222 


The strait- jacket 


224 


The mask .... 


226 


Enlarged tonsils .... 


134 


Excitement ..... 


280 


Feeding after the first year 


74 


Fever ..... 


238 


First aid to the baby 


291 


Fissures of the anus 


235 


Flies and mosquitoes 


288 


Food formulas .... 


3H 


Beef -juice .... 


3H 


Beef, mutton, and chicken broth 


3H 


Scraped beef .... 


3H 


Egg-water .... 


315 


Oatmeal jelly 


315 


Wheat jelly and barley jelly 


315 


Barley-water .... 


315 


Rice-water .... 


315 


Dextrinized barley-water 


315 


Oatmeal-water 


3i6 


Imperial granum-water . 


316 



x Contents 






PAGE 


Food formulas — Continued 




Whey 


316 


Junket ..... 


316 


Cornstarch Pudding 


317 


Prune Juice .... 


317 


Soft Custard . 


317 


Coddled Egg .... 


318 


Foreign bodies in the ear and nose . 


295 


Foreign bodies swallowed 


294 


General Instructions 


313 


German measles .... 


I 7 8 


Germs 


289 


Glands ..... 


219 


Acute enlargement of the glands of th( 




neck ..... 


219 


Chronic enlargement of the glands o 


E 


the neck .... 


220 


Grippe ...... 


250 


Habits ..... 


141 


Ear-pulling .... 


144 


The "pacifier" habit 


142 


Masturbation 


145 


Habitual vomiting 


99 


Hand-i-hold mit .... 


143 


Head lice — pediculi capitis 


237 


Height in inches from birth to sixth year 


12 


Hives ...... 


228 


How the child should be fed . . . 


81 



Contents 


xi 




PAGE 


How to examine the throat 


. I48 


How to lift the baby 


12 


Indoor airing .... 


• 301 


Intertrigo ..... 


. 230 


Kissing ..... 


. 28l 


Malaria ..... 


. 24O 


Malnutrition and marasmus . 


IOI 


Maternal nursing .... 


16 


The diet .... 


• 24 


The bowel function 


. 26 


Air and exercise 


• 27 


Regularity in nursing 


. 28 


Signs of successful nursing 


. 29 


Signs of unsuccessful nursing 


• 30 


Signs of insufficient nursing 


35 


Management of abnormal milk coi 


ldi- 


tions ..... 


• 35 


Mixed feeding 


• 38 



Maternal conditions under which nurs- 
ing is forbidden .... 

Conditions which may temporarily 
produce an unfavorable effect upon 
the breast-milk, but not necessitate 
the discontinuance of nursing 

Conditions which call for temporary 
discontinuance of nursing 

Care of the nipples .... 



39 



39 
4i 



xii Contents 






PAGE 


Maternal nursing — Continued 




Giving of water 


42 


Frequency of nursing 


43 


Measles ..... 


188 


Milk-crust 


229 


Milk for travelling 


92 


Milk in infants' breasts . 


135 


Mumps ..... 


179 


Night terrors .... 


305 


Nose-bleeds ..... 


294 


Nursery-maids .... 


128 


Patent medicines .... 


297 


Pneumonia ..... 


171 


Premature and congenitally weak infants 


213 


Prickly heat .... 


232 


Retention of urine 


275 


Rheumatism .... 


249 


Rickets ..... 


244 


Scales for weighing 


306 


Scarlet fever .... 


175 


Scurvy ..... 


246 


Sick-room for contagious diseases — quar 




antine .... 


191 


Disinfectant drugs . 


194 


Sleep ...... 


282 


Position when sleeping 


12 



Contents 



Xlll 



Sprue and thrush . . . . .149 

Sterilization and pasteurization of 

milk ...... 56 

Stomatitis, or sore mouth . . -151 

Summer diarrhoea . . . .105 

Bowel irrigation . . . .109 

Prevention . . . . .110 

Reduction of food . . . .110 

Cleanliness . . . . .111 

Summer resorts ..... 297 

Taking cold . . . . 153 

Temperature, and how to take it .135 

The baby-basket and its contents . 1 

The care of the eyes . . . .119 

The daily outing ..... 300 

The delicate child . . . . .196 

Normal development . . .196 

Abnormal development . . 197 

Management . . . 197 

Regular weighings necessary . .199 

Feeding delicate infants . . . 200 

Diet after the first year . . . 203 

Baths ...... 204 

Fresh air .... . 206 

Sleep ...... 207 

The nursery ..... 208 

Influence of climate . . . 209 

Clothing . . . . .211 



XIV 



Contents 



The Delicate Child — Continued 

As to the nature of the clothing 

Exercise 

Midday nap . 

Entertainment 

Education 
The exercise pen . 
The first duty to the Child 
The hair 

The normal throat 
The nursery . 

The nursing-bottle and nipple 
The proprietary foods 

The uses of proprietary dried-milk 
foods . 

Proprietary foods to which fresh 
cows' milk is added 

The proprietary beef foods 
The selection of milk 
The skin in health 
The teeth . 

The care of the teeth 

The permanent teeth 
The trained nurse 
The weight of the well baby 
The well baby 
The wet-nurse 
Tonsillitis 
Tuberculosis 



211 
211 
212 
212 
212 
308 

6 
127 
146 

14 

59 

87 



90 
92 

53 
221 
124 

125 
126 
129 

9 

7 

43 

162 

241 



Contents 


XV 




PAGE 


Vaccination ..... 


268 


Vomiting ..... 


98 


Weaning ..... 


50 


Care of breasts during weaning 


52 


When to send for the doctor . 


290 


Whooping-cough .... 


182 


Worms ..... 


277 


Round-worms 


277 


Thread-worms 


278 


Tape-worms .... 


279 



ILLUSTRATIONS 



Baby-Basket .... 


2 


Nipple-Shield .... 


■ 42 


English Breast-Pump 


• 50 


Freeman Pasteurizer 


• 58 


Nursing Bottle and Nipple 


60 


The Chapin Dipper 


66 


Hand-I-Hold Mit .... 


143 


The Throat Examination 


148 


Cold Compress .... 


162 


The Holt Croup-Kettle 


169 


Crib Prepared for Steam Inhalation 


170 


The Electrotherm .... 


215 


The Breck Feeder 


218 


Strait-Jacket .... 


225 


Strait-Jacket in Position 


225 


Mask Pattern . 


226 


Mask in Position . 


227 



XVll 



xviii Illustrations 



PAGE 



The Bulb Syringe . . . . .267 

Basket for Early Exercise . . . 304 

Scoop and Platform Scales for Weighing . 307 

Exercise Pen . . . . . . 310 



SHORT TALKS 
WITH YOUNG MOTHERS 






SHORT TALKS 
WITH YOUNG MOTHERS 



THE BABY-BASKET AND ITS 
CONTENTS 

(See Fig. i.) 

A BASKET in which all the toilet necessi- 
**■ ties for the baby may be kept together 
will be found a great convenience when the 
time for their use arrives. 

To be provided : 

A good-sized pin-cushion and pins. 

Puff-box and puff. 

Soap-box containing Castile soap. 

Infant's hair brush and fine comb. 

Eight ounces of a saturated solution of 
boracic acid for mouth and eyes. 

One-half pound of absorbent cotton. 

A package of wooden toothpicks. 

A bottle of white vaseline. 



The Baby-Basket 

A bath thermometer. 
One yard of plain sterile gauze. 
Plenty of soft old linen. 
Six of the best baby towels. 




BABY-BASKET 



A white eiderdown blanket one and one- 
naif yards long. 

One pair of small scissors. 



Clothing 3 

A package of nickel-plated safety-pins 
(three sizes). 

CLOTHING 

Clothing required at birth. — The infant at 
birth requires practically the same clothing, 
winter or summer — three flannel bands, to be 
torn the desired length and width according 
to the size of the baby. This allows for a 
band in use, one to be laundered and one for 
emergency. The band is sewed on every 
day, after baby's bath. Have the needle 
ready for use in a small cushion especially 
for the purpose, and be sure to replace the 
needle when finished. We are very certain 
if the band is put on in this way that baby 
is not crying because pins are sticking in him. 

Three silk and wool (or cotton and wool) 
shirts, high neck and long sleeves (lighter 
weight for a summer infant). 

Five dozen cotton diapers (second size). 

Three flannel slips with button and button 
holes on each shoulder. This type of gar- 
ment prevents unnecessary handling of the 
child. 

Six plain muslin slips. 



4 Clothing 

At six months. — From the third month on, 
according to the season, the child may be put 
in short clothes. The little slips can be cut 
short and a few new ones added. Eight in 
all are sufficient. 

Three stockingette night slips, one easily 
washed every morning. 

Three flannel petticoats, and stockings 
to cover the legs, as they have been kept 
very warm up to this time. In winter a silk 
and wool (or cotton and wool) stocking is 
advisable. A woven band is now used instead 
of the strips of flannel. The shirts are the 
same, except if the summer months have ar- 
rived the baby needs low neck cotton shirts 
instead of woolen ones. 

The number of diapers the baby requires 
should now begin to diminish, for at regular 
intervals he is held on a small chamber to 
urinate. If his bowels move regularly he will 
seldom have a soiled napkin. 

Care of diapers. — Remove when soiled, 
place in covered pail filled with water (which 
should not be kept in the nursery), until con- 
venient time for washing. Wash in hot water 
using a white soap. Boil for 15 minutes, rinse 
thoroughly and dry in open air whenever 



Clothing 5 

possible. A rubber or water-proof cover 
should never be used over the diaper. The 
child has greater freedom if the diapers are 
folded in a rectangular shape instead of the 
usual triangular. Fasten on either side with 
two pins, one at the waist line, one at the side 
of the leg. By removing the two upper pins 
the child can be placed on the chamber with- 
out removing the diapers. 

At the first year. — At about this age the 
child will begin to stand, and he must have 
shoes to support his ankles. Rompers will 
give him freedom and save on the laundry. 
As soon as he is sufficiently trained (about 18 
months), drawers should replace the diapers. 

Laced shoes are best for a walking child, 
but cannot be procured for a small baby. 
When out of doors in winter the child should 
have his ears well covered, and a bonnet with 
an interlining should be used. A thin 
sweater is a convenient garment to use under 
the coat on very cold days. The child should 
never go out when the thermometer is under 
I5°F. A fine piece of cheese-cloth may be 
made to fit the baby carriage, fastened on the 
hood, and this will guard against dust and the 
high winds. 



6 First Duty to the Child 

The out-of-door clothing is dependent en- 
tirely upon the season of the year and with 
the sudden changes which take place in this 
climate definite rules can not be laid down. 
Mothers are obliged to rely upon their own 
judgment, or that of experienced friends. 
As a general proposition it may be said that 
infants are very apt to be overclad, particu- 
larly during the hot weather. 

THE FIRST DUTY TO THE CHILD 

With the severing of the umbilical cord 
the child begins an independent existence. 
It is made to cry, the eyes and mouth receive 
attention, when it is wrapped in a soft, warm 
blanket and placed out of draughts until it 
can be given further attention. During the 
excitement of the occasion and the needs of 
the mother the baby is sometimes neglected, 
often with serious consequences. I once 
saw, with another physician, a fatal case of 
pneumonia in a child four days old, the dis- 
ease being due in all probability to neglect. 
It must not be forgotten that the baby has 
been suddenly transported into an entirely 
different sphere of action from that to which 



The Well Baby 



he is accustomed, and we must make the 
change as easy for him to bear as possible. 
As soon as the nurse can devote her attention 
to the baby he should be gently and thor- 
oughly oiled with liquid albolene or sweet oil. 
This is to be followed later by a sponge bath 
with lukewarm water and Castile soap. The 
stump of the cord should be dusted with some 
dry antiseptic powder and wrapped in dry, 
plain sterile gauze. The cord, particularly 
at its junction with the abdomen, should be 
thoroughly dusted twice a day. When it falls 
off, the parts should be kept dusted and 
dry until cicatrization is complete. The 
following powder has proven most satisfac- 
tory in my hands : 

Salicylic acid, 15 grains. 
Powdered starch, 1 ounce. 
Powdered oxide of zinc, 1 ounce. 

THE WELL BABY 



In order to appreciate disease or failure in 
proper growth and development, it is neces- 
sary to know what constitutes a well baby. 
The well baby grows steadily, shows an in- 
crease in weight of from five to six ounces a 



8 The Well Baby 

week, the muscles are firm, the skin clear, 
and the eyes bright. When hungry he makes 
it known by crying lustily. At the com- 
pletion of the feeding he gives evidence of 
comfort by drowsiness, or by falling asleep. 
There are two or three soft orange yellow 
stools daily. After the second month the well 
baby appreciates a moderate amount of atten- 
tion, and is attracted to bright objects and 
pleasant faces. His sleep is restful and he 
wakes good-natured unless he is hungry. It is 
not to be understood that the well baby cries 
only when hungry. He often cries while being 
undressed, when the clothing is uncomfortable, 
when objectionable people appear before him, 
or when suffering from pain. 

At the fourth or fifth month he should be 
able to hold his head erect without support; 
from the sixth to the seventh month — at 
this time the first tooth is usually cut — he 
acquires the power of sitting up without assist- 
ance; from the ninth to the tenth month he 
begins to creep, and from the twelfth to the 
eighteenth month he learns to walk alone. A 
very few children walk alone before the 
twelfth month; the great majority, however, 
are from fifteen to eighteen months before 



Weight of the Well Baby 9 

this important feat is accomplished. There 
is nothing to be gained and much harm may 
be done by parents favoring early walking. 
When the child learns to walk unaided, it is 
usually safe to allow him to continue, unless 
he is very heavy. A child four or five pounds 
over weight should be carefully watched and 
the walking prevented to any extent until he is 
seventeen or eighteen months of age. Early 
walking in these heavy children is very apt 
to produce flat feet, knock-knee, or bowed- 
legs. 

THE WEIGHT OF THE WELL BABY 





BOYS 


GIRLS 


Average weight at birth 


7-55 lbs. 


7.16 lbs. 


<< « 


' " three months 


11.75 " 


11. 5 " 


n i 


1 "six months 


16. 


15-5 " 


ii < 


1 " nine months 


18. 


17-75 " 


<« i 


• " twelve months 


20. " 


19.8 " 


<< < 


' " eighteen months 


22.8 " 


22. 


ii i 


1 " two years 


26.5 " 


25-5 " 




1 " three years 


31-5 


30. 


i< i 


" four years 


35- 


34- 




" five years 


41.2 " 


39-8 " 


" six years 


45-1 " 


43-8 " 



Weighing the baby. — Every child under 
one year of age should be weighed once a 



io Weight of the Well Baby 

week. The very weak and delicate and 
those who are being put through a new course 
of dietetic treatment on account of failure in 
growth, should be weighed two or three times 
a week. 

Gain in weight. — An infant is doing fairly 
well who gains on an average four ounces a 
week, ten months in the year. Such a child, 
however, needs careful watching. If he gains 
six ounces a week, we are perfectly satisfied 
with his progress. 

The weight chart. — The use of the weight 
chart I do not advise. Such a chart, while 
recommended by many well-known writers, 
has been the cause of serious trouble. The 
mother and nurse wish the baby's weight 
chart to make a good showing — to show 
something phenomenal if possible — for the 
admiration of relatives and friends. Some 
perfectly well, vigorous babies increase in 
weight slowly, but a gain of only four or five 
ounces a week — below the standard of her 
neighbor or the normal weight line on the 
chart — makes a very unsatisfactory chart, 
and the mother in consequence begins to worry, 
fearing that her baby is not being properly 
nourished. Worry and anxiety have caused 



Weight of the Well Baby 1 1 

the milk of hundreds of mothers to fail, and 
rendered further nursing impossible. If the 
babe is wet-nursed and the chart does not show 
a large gain, the mother is unhappy, the family 
generally is dissatisfied, the wet-nurse sulks, 
and, fearing lest she lose her position, her 
milk soon fails and she is unable to nurse 
the baby. If the baby is bottle-fed, there 
is a strong tendency to overfeed him in order 
to make a pretty chart, and as a result the child 
is made ill. 

The gain in weight is much less in summer 
than during the cooler months. I have seen 
many children in perfect health pass through 
July and August without gaining an ounce; 
but with the arrival of cooler weather they will 
surely make up for the time lost. 

Early loss in weight. — There is usually 
a decided loss in weight the first four days 
of life. This loss — from a quarter to a half 
pound — will usually be regained in five or six 
days if the child is properly fed. 

Weight at age of one and two years. — At 
the end of the first year the child should weigh 
two and one-half times as much as at birth. 
There should be a gain of about seven pounds 
during the second year. 



i2 Height in Inches from Birth 



HEIGHT IN INCHES FROM BIRTH TO 
SIXTH YEAR 



At birth 
Boys, 20.6 
Girls, 20.5 

18 months 
Boys, 30 
Girls, 29.7 

Four years 
Boys, 38 
Girls, 38 



6 months 
254 

Two years 
32-5 
32.5 

Five years 

417 
41.4 



12 months 
29 
287 

Three years 
35 
35 

Six years 
44.1 
43-6 



HOW TO LIFT THE BABY 

A baby should be lifted by placing one hand 
under the buttocks and the other under the 
head. Until the fifth or sixth month is 
reached, a child should never be raised with 
head unsupported. 



POSITION WHEN SLEEPING 

It is best to train the baby to rest on his 
stomach when sleeping. This helps to give the 



Position When Sleeping 13 

child a more erect figure later on. A pillow 
should never be used. 

It is much more convenient when dressing 
or changing the baby if he is placed on a small 
table. 



THE NURSERY 

The nursery should be the largest and best 
ventilated bedroom in the house. In a city 
home it is best to have it on the third or 
fourth floor with a southern exposure. In 
apartments, quiet and the possibility of free 
ventilation and sunlight must be considered 
in selecting the room. For the sake of quiet 
the nursery should not communicate with the 
sleeping-rooms of older children. 

Air capacity of sleeping-room. — In placing 
children in sleeping-rooms or in a nursery, or 
in estimating the capacity of hospital wards 
for children, it is to be remembered that at 
least one thousand cubic feet of air-space 
should be allowed to each child. 

The floor of the nursery should not be 
carpeted. A hard-wood floor is best. If this 
is not possible, covering the floor with oil- 
cloth or linoleum is always possible. This can 
be cleaned with a damp cloth every day. A 
broom should never be used in a nursery. 
Paint or hard finish on the walls is preferable 

14 






The Nursery 15 

to paper. There should be at least two win- 
dows and an open fireplace. If possible, the 
bath-room should be connected with the nurs- 
ery, to be used not only for bathing the child 
but as a "changing room." The child's nap- 
kins should not be changed in its living-room 
if it can be avoided. It is needless to say that 
napkins should never be dried in the nursery. 

Furnishings. — The furniture of the nursery 
should be of the plainest. Hard-wood chairs 
and tables with enamel or brass cribs or bed- 
steads should be used. There should be no 
article of furniture or furnishings in a nursery 
that cannot be washed. 

There should be two shades at each win- 
dow, a light and a dark shade, so that it will 
be possible to darken the room during the 
sleeping time, as well as to exclude the early 
morning light, which is the usual cause of too 
early waking. Babies should be taught to 
sleep until at least six o'clock in the morning. 
This is far better for the child and also for 
the mother if she occupies the same room. 
The unnecessary habit of an early waking at 
four or five o'clock will in most instances 
readily be broken by keeping the room dark. 

Ventilation. — The nursery should have 



1 6 Maternal Nursing 

suitable means for ventilation. For this pur- 
pose, aside from the fireplace, I have found 
the window board of no little service in cold 
weather. It can be made of any width. 
Ordinarily, I have it made about four inches 
wide. It is sawed so as to fit tightly under the 
lower sash. This leaves an open space corre- 
sponding to the width of the board between 
the upper and lower sash, and allows the en- 
trance of a current of air which is directed 
upward. 

Room temperature. — There should be a 
thermometer in every child's living-room or 
nursery. It should register from 65 to 68° 
F. by day and from 50 to 6o° F. by night. 
The nursery should be given an hour's airing 
twice a day. The child should sleep alone in 
its crib. It should not sleep with an adult or 
an older child. 

MATERNAL NURSING 

Writers on this subject are very apt to 
state that the ability of the mother, particu- 
larly among the well-to-do, to fulfill this most 
important function is surely decreasing. This 
may have been a true statement several years 



Maternal Nursing 17 

ago; at the present time, however, I am sure 
it is erroneous. In my own medical life I 
have seen a change for the better, particularly 
during the past ten years. The young mother 
of to-day is better able to nurse her offspring 
than was her own mother. I attribute this to 
the fact that the youth of the present day are 
more vigorous, more nearly normal individuals 
than were their grandparents. The inability 
to perform the nursing function so that it will 
be successful has always been attributed to the 
mother per se. This, I think, is an error. Not 
every breast-milk for two or three weeks 
after parturition is ideal, as I have found by 
the examinations of hundreds of them. If a 
child is born with a generally enfeebled vital- 
ity, it keenly feels any slight abnormality in 
the milk, or it may not be able to digest per- 
fectly normal milk; in either event, the milk 
disagrees and the nursing is discontinued. 
Breast-milk during the first two or three 
weeks of the infant's life is produced under 
conditions which are unfavorable — conditions 
which do not indicate the possibilities of the 
breast as a secreting organ. Following, as it 
does, upon the stress of confinement, it is not 
indicative of what may be possible later when 



1 8 Maternal Nursing 

the customary life and daily habits are re- 
sumed. Repeatedly I have found overrich 
milk or very poor milk during the first week 
or two, entirely corrected later without inter- 
ference. 

Influence of the daily life. — The change 
which enables more mothers successfully to 
nurse their infants is due to two causes — 
more vigorous fathers and mothers and more 
vigorous offspring. Following this line of 
reasoning, the more normal the mother, the 
better able is she to perform this normal func- 
tion. That this is the case is due, I believe, 
to the fact that growing girls and young 
women are leading more hygienic lives than 
formerly. The making of golf, bicycle and 
horseback riding, boating, and automobiling 
popular and fashionable — in short, the taking 
of girls out-of-doors and keeping them there 
a considerable portion of the day — has worked 
a marvellous change for the better, both physi- 
cally and mentally. A neurotic mother makes 
the poorest possible milk-producer. Propor- 
tionate to the population, there are fewer 
neurasthenics among the young women to-day 
than there were twenty years ago, and there 
will be still fewer twenty years hence. At the 



Maternal Nursing 19 

present time the timid, retiring young woman 
of the neurasthenic type is not popular in her 
set. It is a fortunate thing for the future of 
the human race, at least for that portion of it 
which resides in the United States, that the 
young woman has transferred her allegiance 
from the crochet and embroidery needle to the 
golf club. 

Better living practice pervades all classes. — 
It may be said that our argument holds only 
with the wealthy or the well-to-do. Imita- 
tion is one of the strongest characteristics 
of the human race, and this tendency in 
America to outdoor hygienic living pervades 
all classes. Saturday half -holidays, the ex- 
cursions and outings afforded by reduced 
rates of transportation, are much more popu- 
lar than they were ten years ago. Food is 
better selected and better prepared, owing to 
increased knowledge on the part of the people 
as to what constitutes proper nutrition. 

The teaching of right living. — A feature 
which marks an important advance in the 
right direction is the establishment of a de- 
partment in dietetics and food economics in 
the New York Training School for Teachers. 
The Dean, Dr. James E. Russell, in establish- 



20 Maternal Nursing 

ing this course, is producing benefits which 
reach farther than he realises. The students 
are taught food values, food preparation, and 
food economics, which consist in providing 
for a given amount of money the most nutri- 
tious food in its most attractive form. Hun- 
dreds of teachers are sent out from this insti- 
tution every year to take their places of use- 
fulness as instructors of the young in all por- 
tions of the country. Each has learned some- 
thing of food values, and better still each has 
had impressed upon him or her the importance 
of the proper nutrition of a growing child. 
They are taught that, without this, the best 
possible type of adult cannot be produced. As 
a result of such instruction they will be of far 
greater service in their fields of labor, for not 
only can they teach what is laid down in the 
books, but, what is equally if not more impor- 
tant, they are competent to teach those under 
their care how to live; and those who live 
properly, grow properly, following out the 
maxim of Herbert Spencer that "the first 
requisite for success in life is to be a good 
animal; and to be a nation of good animals 
is the first condition of national prosperity." 
It may be thought that we have wandered far 



Maternal Nursing 21 

from our subject — maternal nursing, but such 
is not the case; for conditions which relate to 
this important function, even remotely, demand 
our respectful consideration. The food and 
care of the growing girl have the most inti- 
mate bearing upon her future life, and if she 
is to be called upon to perform the most im- 
portant function of womanhood, she surely 
has the right to demand that she receive dur- 
ing her girlhood proper preparation, which 
heretofore has too often been denied her. 

The duty of the physician. — It is not 
pleasant to criticise physicians; but friendly 
criticism should always be welcomed. The 
family physician does not, in a great majority 
of instances, fulfill his function, or extend 
his field of usefulness to its full capacity, his 
conception of duty too often including only 
the sick. Unsought advice as to the feeding 
and daily habits of a child's life, I find, are 
usually welcomed and appreciated by mothers. 
In practically every instance, according to 
my observation, errors in a child's manage- 
ment are due to ignorance. Mothers, no 
matter what their station in life, are glad to 
do what is for the best interests of their 
children when it is made clear to them. It is 



22 Maternal Nursing 

the duty of the physician to take the mother 
into his confidence and explain to her the 
reasons for the line of action advised. When 
she appreciates the reason for certain pro- 
cedures, I find that she is far more apt to fol- 
low them. 

Possibilities under right management. — I 
am confident from observations upon many 
cases that if I could have the physical direc- 
tion of ten average girls in any station in life, 
provided that they could have the benefit of 
fresh air and good food from infancy to 
adolescence, successful nursing mothers could 
be made out of eight of them. 

Requirements for successful nursing. — Cer- 
tain rules of life having a direct bearing on 
nursing lead us nearer the ideal and may en- 
able one who otherwise could not nurse her 
child to do so successfully. These require- 
ments, it will be seen, are laid along common- 
sense lines and cause no hardships or mental 
distress — one of the chief requirements of a 
nursing woman being that she shall be men- 
tally well balanced and carry out the sugges- 
tions that will follow. 

There are few conditions, in which we are 
called to act, so variable and so uncertain as 



Maternal Nursing 23 

is the production of breast-milk. Breast-milk 
is one of the most precious substances. It is 
invaluable, unless we can put a value on human 
life. 

Successful nursing age. — The most success- 
ful nursing age is between the twentieth and 
thirty-fifth years. I have, however, seen it 
successfully carried on in a girl of fourteen, 
in a woman of fifty-two, and in the much- 
abused society girl, while I have seen it fail 
absolutely in peasant women fresh from the 
fields of Hungary and Bohemia. I have 
seen those in whom at first the nursing was 
most unsatisfactory develop into perfect 
nurses. 

Duration of nursings. — Some mothers will 
be able to carry on the nursings for only two 
months; others, three, five, seven, or nine 
months. In my experience, whether in out- 
patient or in private practice, it is extremely 
rare for the breast-milk to be sufficient for 
the child after the ninth month. 

The following can be laid down as nursing 
axioms : 

A diet similar to what the mother was 
accustomed to before the advent of mother- 
hood should be taken. 



24 Maternal Nursing 

There should be one bowel evacuation daily. 

There should be from three to four hours 
daily spent in the open air with exercise which 
does not fatigue. 

There should be at least eight hours' sleep 
out of every twenty- four. 

There should be absolute regularity in 
nursing. 

There should be no worry and no excite- 
ment. 

The mother should be temperate in all 
things. 

The diet. — I have many times been con- 
sulted by nursing mothers because the nursing 
was unsuccessful or a partial failure, and have 
found that their diet has been restricted to an 
extreme degree. To put on a greatly restricted 
diet a robust young mother who has always 
eaten bountifully of a generous variety of 
foods is one of the best means of curtailing 
the quantity and lowering the quality of her 
milk-supply. When asked to prescribe a diet 
I tell them to eat practically as they were accus- 
tomed to before the advent of pregnancy and 
motherhood. That this particular vegetable 
or that particular fruit should be forbidden, on 
general principles is a fallacy. Food that the 



Maternal Nursing 25 

patient can digest without inconvenience is a 
safe food so far as the nursing is concerned, 
as may readily be determined in any given 
case. If a wide range of diet is prescribed in 
some individuals, a plain, more or less re- 
stricted diet is desirable in others. Many a 
wet-nurse who has been carefully selected, who 
to the best of our judgment should prove satis- 
factory, utterly fails in a few days to fulfill the 
duties of the office for which she was chosen. 
In not a few instances the failure is due to a 
very full diet of unusual articles of food, the 
existence of which, in many instances, she 
never dreamed. Indigestion and constipation 
follow, and both the nurse and the baby are 
made ill and the woman's usefulness ceases. 
A woman who has lived and been well on the 
diet and food found in the home of the labor- 
ing man, whether in the city or country, will 
make a far better wet-nurse on this diet than 
if she indulges in food to which she is entirely 
unaccustomed. 

Nursing is a perfectly normal function, and 
a mother should be permitted to carry it out 
along only natural lines. Inasmuch as there 
are two lives to be provided for instead of one, 
more food, particularly of a liquid character, 



26 Maternal Nursing 

may be taken than she may have been accus- 
tomed to. It is my custom to advise that milk 
be given freely. A glass of milk may be taken 
in the middle of the afternoon, and eight 
ounces of milk with eight ounces of oatmeal or 
cornmeal gruel at bedtime, if it does not dis- 
agree. Our only evidence that a food is not 
disagreeing is the condition of the digestion. 
When any article of food disagrees with the 
mother, or if she is convinced that it disagrees, 
whether or not such is really the case, the food 
should be discontinued. In a general way, 
milk in quantities not over one quart daily, 
eggs, meat, fish, poultry, cereals, green vege- 
tables, and stewed fruit constitute a basis for 
selection. The method of preparation for the 
different meals is not arbitrary. 

The bowel function. — A very important and 
often neglected matter in relation to nursing 
is the condition of the bowels. There must be 
one free evacuation daily. For the treatment 
of constipation in nursing women I have used 
different methods in many cases. The dietetic 
treatment does not promise much. For here, 
again, manipulation of the diet may interfere 
with the milk production. Three methods are 
open to use : massage, local measures, and 



Maternal Nursing 27 

drugs. Massage is available in comparatively 
few cases. Local measures consist in the use 
of enemas or suppositories. Every nursing 
woman under my care is instructed to use an 
enema at bedtime if no evacuation of the 
bowels has taken place during the previous 
twenty-four hours. Many out-patients, in 
whom constipation is very prevalent, indulge 
in excessive tea-drinking, taking often from 
one to two gallons of tea daily. In such 
patients, where an absolute discontinuance of 
the tea-drinking is often impossible and not ab- 
solutely necessary, I usually allow two cups a 
day. When a laxative is necessary, it should 
be prescribed by a physician. 

Air and exercise. — Outdoor life and exercise 
are desirable here as they are under all other 
conditions. In a nursing woman, with her 
added responsibility, they are doubly so. In 
order to get the best results, exercise or work 
should so be adjusted as not to reach the point 
of fatigue. The mother whose nights are dis- 
turbed should be given the benefit of a midday 
rest of an hour or two. She should have at 
least eight hours' sleep out of every twenty- 
four. Certain annoyances, anxieties, and wor- 
ries are inseparable from the life of every 



28 Maternal Nursing 

child-bearing woman. It should be our duty, 
however, to explain to the mother and to other 
members of the family that an important ele- 
ment in satisfactory nursing is a tranquil 
mind. During the lactation period she should 
be spared all unnecessary care and petty annoy- 
ances. 

Regularity in nursing. — The breast which is 
emptied at definite intervals invariably works 
better than does one which is not, not only as 
regards the quantity, but the quality of the 
milk as well; so that system in breast-feeding 
is almost as essential to milk-production as 
to its digestion and assimilation. 

In the vast majority of cases it is best to 
use one breast at a time. Rarely the nursing 
will be better carried on when both are used 
at each feeding. 

The use of one bottle a day. — After it is 
demonstrated that the nursing is progressing 
satisfactorily as proved by the satisfied, thriv- 
ing child, I begin with one bottle-feeding daily. 
The advisability is obvious; in case of illness 
of the mother, if she is called away from home, 
or if, for any reason, the child cannot have the 
breast, the feeding is provided for. Another 
advantage is that it gives the mother needed 



Maternal Nursing 29 

freedom from restraint. She is thus enabled 
to have the benefit of a change of scene. 
Amusements and recreations which the in- 
variable nursing period denies her can be 
indulged in. As a result of this greater free- 
dom, she is able to supply better milk and to 
continue nursing longer than if tied continually 
to the baby, no matter how fond she may be 
of it. 

Signs of successful nursing. — The child 
shows a gain of not less than four ounces 
weekly. This is the minimum weekly gain 
which may safely be allowed. When a nurs- 
ing baby remains stationary in weight or 
makes a gain of but two or three ounces a 
week, it means that something is wrong, and 
it will usually, but not invariably, be found 
in the milk supply. When the baby is nursed 
at proper intervals and the supply of milk is 
ample and of good quality, he is satisfied at 
the completion of the nursing. If he is under 
three months of age, he falls asleep after ten 
or twenty minutes at the breast. When the 
nursing period again approaches, he becomes 
restless and unhappy, crying lustily if the 
nursing is delayed. When the breast is offered, 
he takes it greedily. The stools are yellow 



3° Maternal Nursing 

and number from two to three daily. The 
weekly gain in weight under such conditions 
is usually from six to eight ounces. 

Signs of unsuccessful nursing. — Theoreti- 
cally, every normal breast baby should be a 
thriving, well baby. That such is not the case 
is an unfortunate fact. The standard estab- 
lished for a well baby is not upheld here. When 
the supply of milk is scanty the child remains 
long at the breast and cries when he is re- 
moved. He shows signs of hunger before 
the nursing hour arrives. A course of failure 
in breast-feeding, and probably the most fre- 
quent cause, is a scanty milk-supply. The 
chief nutritional elements in mother's milk 
are : fat, 3 to 4 per cent. ; sugar, 7 per cent. ; 
proteid, 1.5 per cent. Failure may be due to a 
marked disproportion of these elements, which 
may cause sufficient indigestion and resulting 
loss in weight to necessitate the discontinuance 
of nursing. Thus there may be a high fat — 
from 5 to 6 per cent. ; or very low fat — from 
1 to 1.5 per cent. In the high-fat cases there 
will usually be diarrhoea with green, watery 
stools. The child strains a great deal and 
there are green stains on many of the napkins. 
In high-fat cases there is also regurgitation or 






Maternal Nursing 3 l 

vomiting of sour material. Low fat means 
deficient nourishment and may cause constipa- 
tion. Sugar is rarely a cause of trouble in 
nursing babies. It seldom varies, ranging 
from 5 to 7 per cent, in the great majority of 
breast-milks. Young children, further, have a 
marked toleration for it. The proteid of 
mother's milk is the most frequent cause of 
nursing difficulties. Like the fat, it may so be 
decreased that nutritional disorder may be in- 
duced in the patient, or it may be very much 
increased; the latter being usually the cause of 
colic or constipation in otherwise healthy nurs- 
ing infants. In such infants curds may be 
found in the stools, the passage of which is 
always accompanied by a great deal of gas. 
The milk may contain the normal percentage 
of fat, sugar, and proteid, but be scanty in 
amount. Instead of the four or five ounces 
to which the child is entitled, he may get but 
one or two ounces. Whether or not the quan- 
tity is sufficient can be determined by weighing 
the baby before and after each nursing, for 
twenty-four hours. One ounce of breast- 
milk practically weighs one ounce avoirdupois. 
The quality or strength is determined by an 
examination of the milk itself by the physician. 



32 Maternal Nursing 

Before nursing, the child is put in the scales 
without undressing him and the weight noted. 
He is allowed to nurse fifteen minutes. He is 
then removed from the breast and weighed. 

Amount of milk required.— A child under 
one week should have gained from i to 2 
ounces; at three weeks of age, 2 to 3 ounces; 
four to eight weeks of age, 3 to 4 ounces; 
eight to sixteen weeks of age, 4 to 6 ounces; 
sixteen to twenty-four weeks of age, 6 to 7 
ounces; six to nine months of age, 7 to 8 
ounces; nine to twelve months of age, 8 to 9 
ounces. 

Of course arbitrary limits cannot be fixed 
as to the quality. Stationary weight or loss 
in weight with a dissatisfied child usually 
means defects in quantity which are readily 
proved by the weighing. To be fed at the 
breast may also cause the child to suffer from 
an excess of good milk, in which event there 
will be vomiting or regurgitation, usually asso- 
ciated with colic. When this overfeeding con- 
tinues, dilatation of the stomach develops, 
vomiting becomes habitual, the child loses in 
weight, and the breast-milk is said not to agree, 
and often, unfortunately, the baby is weaned. 
This has been the outcome in scores of cases. 



Maternal Nursing 33 

When there is habitual vomiting and colic in 
a nursing baby, two things are to be done — 
the baby must be weighed before and after 
nursing, and the milk must be examined. 

I have repeatedly treated children for indi- 
gestion who were entirely relieved by shorten- 
ing the nursing period. Weighing the baby 
at intervals of from three to five minutes 
and noting the gain has shown that the three 
or four ounces which may be the child's 
stomach capacity was obtained in two, 
three, or five minutes, the excess which 
the child took over this amount being the 
cause of his trouble. Given a free, full breast 
and a vigorous nurser, and one ounce will be 
taken in one minute. When the nursing 
"gait" is established, a child should be kept 
up to the schedule. There are few more 
pernicious teachings than that a baby should 
be allowed to nurse when he wants to and as 
long as he wants to. The idea that a nurs- 
ing infant will take no more than is good for 
him is the fruit of inexperience. Recently a 
mother consulted me in regard to putting her 
one-month-old baby on the bottle, as he had 
many green stools, cried a great part of his 
waking hours, and weighed but a few ounces 



34 Maternal Nursing 

more than at birth. Her milk was supposed 
to be "too strong" for the child. An examina- 
tion of the breast and a talk with the mother 
satisfied me that the breast-milk was not at 
fault. An examination of the milk proved 
it to be good average milk — 3.5 per cent, fat, 
6 per cent, sugar, 1.45 per cent, proteid. A 
one-day's test by weighing was decided upon. 
He was allowed to nurse one minute and rest 
one minute. During the resting period he was 
weighed. Weighing and resting him in this 
way, it was found that in three minutes he got 
from 3 to 2>V2 ounces of milk. The nursing 
was then reduced to three minutes on one 
breast and five minutes on the other, which 
was the ' 'slower" breast of the two. Every 
sign of indigestion promptly disappeared 
after this change. The stools became normal 
and the infant made a satisfactory gain in 
weight of one ounce daily. 

Necessity for milk examination. — The quan- 
tity may be suitable for the age of the child, 
he may not vomit or show a sign of indiges- 
tion, and yet he may not thrive. In such a case 
an examination or repeated examinations of 
the milk at intervals of two or three days will 
usually show that it is poor, below the normal 



Maternal Nursing 35 

perhaps in both fat and proteid. Such a case 
occurred in the New York Infant Asylum. A 
Swedish woman was admitted with an infant 
two months old in fair condition. She had 
an abundance of milk and asked for a foster- 
child, so great was her discomfort from the 
excessive flow of milk. The weekly weighings 
of the children soon revealed that there was no 
growth, and both children upon examination 
showed, after a few weeks, developing rickets. 
The milk was then examined and was found 
deficient in all its constituents. 

Signs of insufficient nursing. — The baby 
remains long at the breast, perhaps one-half to 
three-quarters of an hour. When removed, 
he is restless and uncomfortable. After a 
short time, in an hour or less, he is very hun- 
gry and demands frequent nursings day and 
night. 

Management of abnormal milk conditions. — 
When it is found that the breast-milk is too 
strong or too weak, or when the normal ratio 
of fat, sugar, and proteid are not maintained, 
it may be possible to increase or diminish the 
milk strength. It may also be possible to in- 
crease either the fat or the proteid when 
desirable. The heavy milk will usually be 



36 Maternal Nursing 

found in mothers who are robust, who eat 
heartily, and who take but little exercise. In 
such a mother, the prescribing of a plain diet, 
allowing red meat but once a day, discontinu- 
ing the malt liquors or wine— which it will 
often be found that she is taking, — and direct- 
ing that she walk a mile or two a day, will 
frequently bring the milk to digestible pro- 
portions. In some cases, however, this will 
not be successful, and the colic, constipation, 
and vomiting continue, even though the quan- 
tity obtained at each nursing is within normal 
limits. In some mothers it will be impossible 
to change the mode of life, except perhaps as 
to the discontinuance of alcohol. When such 
conditions prevail, the mother's milk may be 
modified by giving from one-half to one ounce 
of boiled water or plain barley-water before 
each nursing. This is a procedure to which 
I frequently resort. One teaspoonful of lime- 
water added to one ounce of water before each 
nursing has made the breast-milk agree when 
otherwise it would have been impossible. 
When the milk is deficient both in fat and 
proteid, a diet composed largely of red meat, 
poultry, fish, rye, bread, or whole-wheat 
bread, oatmeal, cornmeal, with two or three 



Maternal Nursing 37 

pints of milk daily, will often bring the milk 
to the normal requirements. The use of alco- 
hol in moderate amounts, in the form of malt 
liquors or wine, will usually increase the fat. 
I have frequently seen it advance 2 per cent, 
in from two to three days. Disappointments 
in improving the quantity or quality of the 
breast-milk, however, are frequent. 

In addition to the one bottle which, for 
reasons above mentioned, is given early in the 
child's life, I find it necessary at the seventh 
month to add an extra bottle or two. Usually 
at this time the proteid in human milk begins 
to diminish in quantity, and as this is the most 
important nutritional element, an insufficient 
quantity at this rapidly growing period of life 
is a matter of no little importance. At the 
twelfth month, with very few exceptions, my 
nursing babies are weaned from necessity. At 
this age exclusive nursings, if one considers 
the best interests of the child, are practically 
out of the question. Out of many thousands 
of mothers I recall but one instance where a 
mother was able successfully to nurse her child 
after the twelfth month. This remarkable 
woman, the mother of six children, had nursed 
every one of them exclusively and successfully 



38 Maternal Nursing 

up to the fifteenth or the eighteenth month. 
Mixed feeding. — With a diminution in the 
amount of milk secreted, the breast milk must, 
of course, be supplemented by modified cow's 
milk. This method of feeding is usually suc- 
cessful. If the mother of a six-months-old 
baby can satisfactorily nurse him three times 
in twenty-four hours, he is given, in addition, 
three bottle-feedings in the twenty-four hours, 
in this way supplementing the mother's milk, 
or the following method may be employed. 
Weigh the baby without undressing before 
placing him to the breast and again when the 
breast is empty, by this means the amount ob- 
tained is readily learned and a supplementary 
feeding, one or two or more ounces, may be 
given by bottles to supply the amount required. 
The modified milk strength should be that 
which is suitable for the average child of his 
age. (See Infant Feeding, page 65.) In be- 
ginning the use of cow's milk, however, it must 
be remembered that at first a weaker strength 
must be used than the child will require for 
growth, this weaker food being necessary in 
order gradually to accustom him to the change 
of food. If too strong a cow's-milk mixture 
is given at first, it will be very apt to disagree, 



Maternal Nursing 39 

causing colic and vomiting. Later, when the 
child has become accustomed to the new food, 
a stronger mixture may be given. When a 
mother cannot give her infant at least two satis- 
factory breast-feedings daily, it is better to 
wean the child. 

Maternal conditions under which nursing is 
forbidden. — When the mother has tubercu- 
losis in any of its various forms or manifes- 
tations, whether it involves the glands, the 
joints, or the lungs, breast-feeding is to be for- 
bidden. In epilepsy and syphilis nursing is 
likewise forbidden. In nephritis and malig- 
nant disease of any nature, and in chorea, nurs- 
ing should be discontinued. Women who are 
rapidly losing weight should not continue 
nursing their infants. In case of serious ill- 
ness of any nature, such as typhoid fever, 
pneumonia, or diphtheria, and upon the advent 
of pregnancy, nursing should be stopped. 

Conditions which may temporarily produce 
an unfavorable effect upon the breast-milk, 
but not necessitate the discontinuance of nurs- 
ing. — The advent of the first menstruation 
period particularly, and in some cases of every 
menstruation period, is attended with an at- 
tack of colic or indigestion on the part of the 



4° Maternal Nursing 

child, rarely sufficient, however, to necessitate 
the discontinuance of the nursing even for a 
single day. 

Factors influencing the mental conditions 
of the mother, such as anger, fright, worry, 
shock, distress, sorrow, or the witnessing of 
an accident, may affect the milk secretion suffi- 
ciently to cause no little discomfort to the child, 
and oftentimes the temporary lessening of the 
flow for a day or two. The influence of the 
mental state upon the character of the milk 
was early brought to my attention while resi- 
dent physician at the Country Branch of the 
New York Infant Asylum. In this institution 
there were usually about two hundred nursing 
mothers, the majority of them from the lower 
walks of life, at least 95 per cent, of the in- 
fants being illegitimate. The necessity of 
placing a considerable number of these mothers 
in wards, and their living thus in close contact, 
gave rise to rather frequent disputes, and not 
infrequently to fistic encounters of a decidedly 
vigorous character. After a particularly active 
disturbance, several nursing infants in the ward 
would be taken suddenly ill, usually with 
vomiting, diarrhoea, and fever. When two 
or more infants were thus discovered ill, we 



Maternal Nursing 4 1 

soon learned to know the cause when inquiry 
or evidence furnished by hasty inspection of 
the mother showed that she had been particu- 
larly active in the affair. A small proportion 
of the mothers were from the better walks of 
life. Letters of forgiveness or reproach or 
visits of a like nature from fathers, mothers, 
or sisters, have brought many a sick baby to 
my attention and caused me many anxious 
moments. 

Conditions which call for temporary discon- 
tinuance of nursing. — During an acute illness 
with fever, such as indigestion, tonsillitis, and 
minor illness of like nature, nursing should 
be discontinued for a day or two. When the 
infant is removed from the breast, it should 
be our effort to maintain the flow of milk. 
This is best done by emptying the breast with 
a breast-pump (page 49) at the usual nursing 
period until the time arrives when the nursing 
may be resumed. In such conditions the ad- 
vantage of having the baby accustomed to one 
bottle a day will at once be appreciated. 

Care of the nipples. — Six hours after de- 
livery or confinement, the nipples should be 
washed with a saturated solution of boric 
acid and the child put to the breast and nurs- 




4 2 Maternal Nursing 

ing attempted. After this, the attempts at 
nursing should be repeated 
every four hours, although 
the milk does not appear 
in the breasts until from 
forty-eight to seventy-two 
hours after the birth of the 
child. Colostrum may be 
present, which is useful as 
a laxative and may satisfy 
the child. A further ad- 
vantage of the nursing at 
fig. 2. nipple-shield this time is that it grad- 
ually accustoms both the 
nipple and the infant to what will be required 
of them later. Immediately after the nurs- 
ing the nipple should be carefully washed 
with a saturated solution of boric acid and 
thoroughly but gently dried. A baby should 
never be allowed to nurse on a cracked or fis- 
sured nipple. For this very painful condition 
a nipple-shield (Fig. 2) should always be used. 
Giving of water. — From one-half to one 
ounce of a 1 per cent, solution of milk-sugar 
should be given the infant every two hours 
until the milk appears in the breast. Other- 
wise there will be unnecessary loss in weight 



The Wet-Nurse 43 

and perhaps a high degree of fever due to in- 
anition. 

If the child is restless and uncomfortable, 
it is safe to conclude that he is thirsty, and 
one ounce of the sugar-water will usually 
satisfy him. With the commencement of 
nursing, accustom the baby to getting his food 
at regular intervals. 

Frequency of nursings. — The new-born 
infant is entitled to seven nursings in twenty- 
four hours. From 6 a.m. to 10 p.m., inclu- 
sive, there should be six nursings. There may 
be one nursing at 2 or 3 a.m. As the child 
becomes older less frequent nursings are re- 
quired. The following table will be found 
useful in this connection: 

Fifth to the twelfth month 5 nursings. 

Third to the fifth month 6 " 

Third day to the twelfth week 7 " 

THE WET-NURSE 

We are called upon to select a wet-nurse 
under various conditions. In a few families, 
particularly in those who have had disastrous 
feeding experiences, we are asked that no at- 
tempts at artificial feeding be made, but that 



44 The Wet-Nurse 

a wet-nurse be engaged in advance of the con- 
finement so as to be ready when the time for 
her services arrives. Usually, however, our 
minds turn to the wet-nurse when nutrition 
by other methods is a failure. It is well to 
remember in this connection that it is not wise 
to postpone our resort to the wet-nurse too 
long — until every chance of her being of as- 
sistance has passed. It may take a few days' 
observation or but a single glance at one of 
these difficult feeding cases for us to decide 
whether a wet-nurse must be secured. Certain 
it is that in a few cases we cannot do without 
them. I see perhaps two or three cases a year, 
usually in consultation, in which I insist that 
further attempts at artificial feeding be discon- 
tinued because of the reduced condition of the 
patient. 

Age of the wet-nurse. — In the selection of a 
wet-nurse the age during which nursing is 
most successfully carried on is to be remem- 
bered. Other things being equal, a wet-nurse 
should not be under twenty-two or over thirty- 
five years of age. The peasant woman of the 
continent of Europe make the best wet-nurses. 

Type of woman required. — A woman should 
not be selected as a wet-nurse without a thor- 



The Wet-Nurse 45 

ough examination both of herself and of her 
infant. She must be free from skin diseases, 
tuberculosis, and syphilis. Whether she is 
stout or thin, tall or short, amounts to little. 
Neither can we place much reliance on the 
size of her breasts. Although full, firm 
breasts and prominent nipples are desirable, 
the best indication as to her nursing ability is 
the condition of her baby. For this reason it 
is best not to select a woman before her baby 
is four weeks old, for by that time his physi- 
cal condition will indicate with considerable 
accuracy the kind of food he has been getting. 
The age of the wet-nurse's milk need not corre- 
spond with the age of the patient for whom 
she is engaged. As far as age is concerned, a 
breast-milk from four weeks to three months 
old will answer for any infant. 

The results attending the first few days of 
wet-nursing are often most disappointing. 
The radical change which takes place in the 
nurses's habits of life, the leaving of her own 
child to the care of others, sometimes pro- 
duces nervous conditions which may have a 
decidedly unfavorable influence upon her milk. 
So before arriving at the conclusion that she 
will not answer in a given case, she should have 



46 The Wet-Nurse 

time to adjust herself to the changed condi- 
tions. 

Diet of the wet-nurse. — Many a good wet- 
nurse has been ruined, so far as her usefulness 
as a milk-producer is concerned, by over- 
indulgence at the table. She has been accus- 
tomed to a very plain diet and some work, 
which necessarily means exercise. Upon as- 
suming her new office she is temporarily the 
most important member of the household, 
next to the baby, and articles of food are sup- 
plied to which she is entirely unaccustomed 
and of which she eats plentifully. The result 
is an attack of indigestion with fever, the baby 
is made ill, and the usefulness of the wet-nurse 
in the family ceases. These women usually 
do best upon a plain diet of meat, poultry, fish, 
vegetables, cereals, and milk. If they are ac- 
customed to taking beer, one bottle daily may 
be permitted. Coffee may be allowed to the 
extent of one cup daily, and of tea not more 
than two cups should be allowed. 

The bowel function. — Women of this class 
are almost invariably neglectful of the bowel 
function, so that this must be attended to. 
One free evacuation should take place daily. 
As a rule, the wet-nurse has been accustomed 



The Wet-Nurse 47 

to work and will be more contented and happy 
when her time is occupied. Being out-of- 
doors from three to four hours a day is of 
decided advantage to every nursing woman. 
If she possesses sufficient intelligence to take 
the baby for his outings, she should be allowed 
to do so. For the comfort of the family, it 
is wise not to let a wet-nurse know her full 
value. When she feels that she is indispen- 
sable, trouble is apt to follow from one source 
or another. 

One bottle daily. — It is particularly neces- 
sary, therefore, that babies that are wet- 
nursed should be given one bottle-feeding 
daily as soon as they are able to take care of 
it. The wet-nurse will then realize that she 
can be dispensed with in case of misconduct, 
or if she leaves at an hour's notice the child 
can be given the bottle until another nurse is 
secured. In the great majority of my cases it 
has not been necessary to continue the wet- 
nursing after the children are seven months 
of age, for by this time they can usually be 
fed on the bottle. Of course, unless her nurs- 
ing proves unsatisfactory, a wet-nurse should 
not be dismissed at the commencement of or 
during the summer. 



4 8 Care of the Breasts and Nipples 

CARE OF THE BREASTS AND 
NIPPLES 

After nursing is well established the baby 
should be nursed at three hour intervals dur- 
ing the day. If he sleeps betwen 10 p.m. 
and 6 a.m. do not wake him. One feeding at 
2.30 a.m. is required by a few children up to 
the third month; the great majority, however, 
do better without it. Before and after each- 
nursing the mother's nipples should be gently 
washed with a saturated solution of boracic 
acid, using either clean old linen or absorbent 
cotton. The nipples should be thoroughly 
dried after the washing. 

Cracked and fissured nipples. — Nursing 
is often most painful on account of cracks 
and fissures in the nipples. These are very 
apt to occur if the parts are neglected, and 
the resulting pain when the child nurses is 
unbearable, necessitating sometimes the dis- 
continuance of the breast-feeding. The baby 
should never be allowed to touch a cracked 
or fissured nipple, and a nipple-shield (see 
Fig. 2) should be used until the parts are 
healed. Some babies take very kindly to the 
nipple-shield, and often a great deal of patience 



Care of the Breasts and Nipples 49 



must be exercised before they can be taught 
its use. If the shield suggested does not an- 
swer, others may be tried. The breast should 
never be allowed to become hard or painful. 
If the child does not take 
enough to keep the breasts 
soft a breast-pump should 
be used to remove the re- 
mainder. For this pur- 
pose, the so-called Eng- 
lish breast-pump (see Fig. 
3) is the best. With the 
first rush of milk to the 
breast it is often very dif- 
ficult to prevent hard, 
painful nodules from 
forming in the glands. 
The free use of the 
breast-pump and massage 
with warm oil, if proper- " G - 3 
ly carried out, will pre- 
vent the formation of an abscess. 

When the breasts are large and pendulous, 
a support consisting of a bandage firmly ap- 
plied around the chest will often afford much 
comfort and prevent serious trouble. In addi- 
tion to the use of the nipple-shield, the cracked 




ENGLISH BREAST- 
PUMP 



5° Weaning 

nipple should be washed with a saturated 
boracic-acid solution after each nursing, and 
dried, when a soothing ointment may be ap- 
plied on old linen; such an ointment, composed 
of ichthyol fifteen grains, vaseline one-half 
ounce, oxide-of-zinc ointment one-half ounce, 
has given most satisfactory results. The oint- 
ment should be carefully removed with warm 
sweet-oil and the nipple washed in alcohol be- 
fore the next nursing. When the fissures are 
healed, the nursing may be resumed, allowing 
the child for a few days to take the nipple 
every second or third nursing, thus gradually 
accustoming the nipples to the rough usage. 

WEANING 

When is the nursing baby to be given other 
food, or how long can the breast be relied 
upon to furnish the child its sole nourishment ? 
If the mother, unassisted, is able to nourish 
her infant completely until it is seven months 
of age, she is doing remarkably well. There 
are very few nursing mothers who can pass 
that period without assistance. Perhaps one 
or two bottle-feedings a day may suffice. In 
many cases the milk will fail about the seventh 



Weaning 5 1 

month, and absolute weaning be necessary. 
Granting, however, that the child is thriving 
on the breast alone, or doing satisfactorily on 
the breast with only two daily feedings, at what 
age should the weaning take place? I have 
known just one mother out of several thousand 
who could nurse her child to the child's advan- 
tage after twelve months had passed. I have 
seen many pronounced cases of malnutrition 
and rickets due directly to prolonged nursing. 
Indigestion and diarrhoea are often the out- 
come of prolonged breast-feeding. 

The weaning in health should begin not 
later than the twelfth month, and in many in- 
stances it would be to the advantage of the 
child if nursing was interrupted earlier. It is 
best accomplished gradually by substituting 
bottle-feeding for nursing, giving only one 
bottle the first day, two the second, three the 
third, and so on until in a week or ten days 
weaning is complete. In case the child is ill 
we may be obliged to wean at once, when 
bottle-feeding is substituted for the breast, but 
the milk formula corresponding to his age 
should not be given. To a child six months of 
age give the three-months' formula; a child 
nine months of age should receive the six- 



52 Weaning 

months' formula. A gradual increase to the 
formula suggested for a child the age of the 
patient may be made if all goes well. After 
the ninth month it is often possible to feed 
from a cup, which is then to be preferred to 
bottle-feeding as a substitute for the breast. 
It is best not to attempt weaning during the 
hot months unless the conditions demanding 
it are urgent. 

Care of breasts during weaning. — When 
the breast-feeding is carried on the usual 
length of time — from nine to twelve months, 
— the process of weaning ordinarily causes 
little or no discomfort. All that is usually 
required is to press out enough of the milk to 
relieve the patient as often as the breast be- 
comes painful, which may not be more than 
two or three times a day. When the weaning 
is necessarily abrupt, no little discomfort may 
result. If there is a free flow of milk, which 
is apt to be the case when the weaning must 
take place in the early nursing period, tightly 
bandaging the breasts is required. When 
localized hardened areas occur in the glands, 
they should be massaged until softened, and 
the bandage reapplied and worn until the 
secretion ceases. When the weaning can more 



The Selection of Milk 53 

gradually be done, the best way is to give one 
less nursing every second or third day until 
only two are given. After this has been prac- 
tised for one week, these also can be discon- 
tinued. In cases where sudden weaning is 
required, a saline laxative, such as citrate of 
magnesia or Rochelle salts, should be given 
every day for five days — sufficient to produce 
two or three watery evacuations daily. In the 
meantime the mother should abstain from 
fluids of all kinds up to the point of positive 
discomfort. 

THE SELECTION OF MILK 

The selection of the milk on which the baby 
is to live is a matter of no little importance. 
There is a vast difference in the quality and 
cleanliness of the milks on the market. Too 
many mothers look upon all milk as being of 
uniform value because it all has a similar ap- 
pearance. While the general character of the 
milk sold has improved greatly as regards 
cleanliness during the past few years, a great 
deal of that used at the present time is unfit 
for food for a baby. 

Certified milk. — New York City mothers 



54 The Selection of Milk 

should insist that the milk used be bottled and 
sealed at the farm, and also insist that it be 
certified by the New York Milk Commission. 
Milk if properly produced is expensive. The 
most expensive milk will, as a rule, be found 
safest for use. 

Necessary precautions. — When certified 
milk or one of the higher-class milks is not 
obtainable, as is the case with those whose 
home is in the country, and for the families 
from the larger cities who spend the summer 
months in more or less remote country 
districts, the matter of securing a safe milk is 
of vital importance. The average farmer is 
notoriously careless in the handling of milk, 
and in the country districts, where the milk 
supply should be the best, it is often as bad as 
can well be imagined. In the country, where 
the milk is furnished by the farmer direct, a 
special arrangement may be made, by which 
he agrees : that the cow's belly, udder, and 
teats shall be wiped off with a damp cloth be- 
fore milking; that the milker's hands shall be 
washed before milking; that the few jets of 
the fore-milk shall be thrown away; and that 
as soon as the milk is drawn it shall be strained 
through absorbent cotton into a quart milk 



The Selection of Milk 55 

bottle, suitably corked, and placed in a pail 
of cracked ice. The cracked ice and the ab- 
sorbent cotton, are, of course, furnished by 
the consumer. For the extra trouble the 
farmer receives from fifteen to twenty-five 
cents a quart for the milk. The improved 
milk-pail with the small top opening insures 
a much cleaner milk, as it offers much less 
opportunity for droppings to fall into it dur- 
ing the milking. 

For those who have country homes and 
who can control their milk-supply, the above 
precautions may be carried out to the letter. 
By such careful control of the home product, 
and by the use of milk from those dairies only 
which observe the above precautions, the acute 
digestive disorders of summer among my 
patients are rendered a very unusual occur- 
rence. These precautions, with the knowledge 
of the mother or nurse as to what to do at the 
first sign of a digestive disorder, will reduce 
the number of the so-called summer diarrhoea 
cases to a very insignificant figure. 

A further and very essential requirement 
is that all cows used for furnishing milk to 
infants be tested for tuberculosis every six 
months. 



56 Pasteurization of Milk 

Care of the milk after delivery. — There is 
very little gained through the farmer produc- 
ing a clean safe milk and keeping the milk iced 
until delivered if the mother or nurse allows it 
to stand in the hot air of the kitchen and per- 
haps exposed to flies and other insects. As soon 
as received the milk should be placed in the 
ice-box on the ice, not in the compartment be- 
low where the vegetables and meats are kept. 
Here the milk should rest until such time in the 
morning as the mother is able to devote her 
attention to the preparation of the food. When 
the family conditions allow there should be a 
special ice-box for the baby's milk. 

The nursery ice-box should be kept clean 
and filled with ice and contain a thermometer. 
The temperature should not be above 50 . 

STERILIZATION AND PASTEURIZA- 
TION OF MILK 

Sterilized milk is rarely used at the present 
time in routine feeding. Milk is said to be 
sterilised when it has been heated to the boil- 
ing point, 212 F., and kept at this point for 
thirty minutes. 

Pasteurized milk is milk heated to I55°F. 



Pasteurization of Milk 57 



and kept at this temperature for thirty 
minutes. In heating the milk we have two 
objects in view : to kill the harmful micro- 
organisms which it may contain, and to keep 
the milk sweet for a longer time than would 




FIG. 4. FREEMAN PASTEURIZER WITH BOTTLE RACK 
REMOVED 

otherwise be possible. The degree of heat 
to which the milk is subjected should depend 
upon the season of the year, the source of the 
supply, the age of the milk, and the digestive 
capacity of the child. The more the milk is 
heated the more difficult of digestion it be- 
comes, and the more liable it is to produce con- 
stipation; so that, other things being equal, 
the less we heat the milk the better the nourish- 



58 Pasteurization of Milk 

ment we furnish to the child. In country dis- 
tricts where the cows are known to be healthy, 
and the milk clean and fresh, heating is un- 
necessary. In cities and large towns, where 
the source of the milk may be unknown, and 
where it is from twenty- four to thirty-six 
hours old when it reaches the consumer, heat- 
ing to a moderate degree is a safe procedure 
at any time of the year. Pasteurizing the milk 
kills most of the dangerous germs without 
materially affecting the digestibility, or chang- 
ing the taste of the milk. Among the intelli- 
gent and cleanly I advise the pasteurization of 
milk; among the ignorant poor and the care- 
less, — such as we frequently see in out-patient 
work, — the milk should be boiled, particularly 
during the hot months. The pasteurization of 
milk is best accomplished by the use of the 
Freeman Pasteurizer (see Fig. 4). Directions 
for use are furnished with the Pasteurizer. 

If for any reason the Freeman Pasteurizer 
cannot be used, the milk may be heated in a 
double boiler. If this is not at hand an ordi- 
nary agate basin may be used. The vessel 
should be placed over a slow fire, with a milk 
thermometer held in the mixture. When the 
thermometer registers 170 F., remove the 



The Nursing-Bottle and Nipple 59 

milk from the fire and pour it into as many 
bottles as there are feedings in the twenty- 
four hours. Absorbent cotton should be used 
for stoppers. The bottles should be cooled 
rapidly by placing them in cold water. The 
Freeman Pasteurizer should always be used 
if possible, for the reason that it saves much 
trouble, the temperature to which the milk is 
heated is uniform, it requires no manipulation 
of the milk after it has been prepared and 
heated, and there are no chances of the con- 
tamination of the milk from the air. 

THE NURSING-BOTTLE AND NIPPLE 

There are two requirements that a nursing- 
bottle must fulfill : it must have a capacity suffi- 
cient for one full feeding, and it must be so 
constructed as to be readily cleansed. The 
oval bottle (Fig. 5) with rounded edges an- 
swers best. These may be obtained in sizes 
of from three to nine ounces. As many bottles 
are needed as there are feedings in twenty-four 
hours. When the bottle is emptied it should be 
rinsed and filled with cold water. Each morn- 
ing before starting formula, wash all the bottles 
and articles to be used with a stiff brush and 



6o 



Artificial Feeding 




plenty of hot water and a pure soap. Then 
rinse and boil 15 minutes. Boil articles every 
day. The straight, black nipple 
(Fig. 5) is also preferred, for 
the reason that it can be turned 
inside out and easily cleansed. 
A nipple which cannot be turned 
should never be used. After us- 
ing, a nipple should be turned 
and scrubbed with a stiff brush 
and borax water — a tablespoon- 
ful of borax to a pint of water. 
When not in use, the nipple 
should be kept in borax water. 
Before placing it on the bottle it 
should be rinsed in boiled water. 
m^jdr The nipples should be boiled 

fig. 5. nurs- once a da y- The blind ni PP les — 
ing bottle and those without holes — are the 

best. Holes of the required size 

may be made with a red-hot cambric needle. 



ARTIFICIAL FEEDING 
BOTTLE-FEEDING 

When it is decided that the child will have 
to be nourished by other means than the breast, 
we are obliged to furnish a suitable substitute 



Artificial Feeding 61 

for the mother's milk which the child has a 
right to demand. In our selection we must 
be guided by Nature and furnish a food that 
will correspond as closely as possible to the 
mother's milk. This can be done only by the 
use of cows' milk properly prepared and 
diluted. Cows' milk differs from mother's 
milk in its most important constituents. Good 
cows' milk contains primarily 3.50 to 4 per 
cent, of fat, 3.50 to 4 per cent, of proteid, and 
4 ^0 5 per cent, of sugar. Mother's milk on 
the other hand contains 3.5 to 4 per cent, of 
fat, 1.5 per cent, of proteid, and 7 per cent, of 
sugar. It will be seen that cows' milk con- 
tains more proteid (curd) and less sugar than 
is contained in mother's milk. We must en- 
deavor to make the proportion of the important 
constituents of cows' milk — the fat, proteid, 
and sugar — correspond to that of mother's 
milk. This has given rise to the term modified 
milk. Cows' milk is made to correspond to 
that of the mother by diluting it with water 
to reduce the proteid, and then by adding cream 
and milk-sugar to bring up the fat and sugar 
to the required strength. 

The term modified milk is not a good one, 
for the term "modified" does not cover all 



62 Artificial Feeding 

that is done in rendering cows' milk a suitable 
diet, that is, changing it to correspond to 
mother's milk. We would have very little suc- 
cess in infant feeding if this were all we did. 
The milk must be adapted to a child's age and 
peculiarities, so that the term adapted milk 
expresses far better what we wish to accom- 
plish. In adapting milk to an infant, we must 
remember that cows'-milk proteid (curd) is 
more difficult to digest than the proteid of 
mother's milk, and that frequently a smaller 
amount of fat must be given than is contained 
in mother's milk. Particularly must these pre- 
cautions be observed in the very young and 
delicate. The gravest error, and one most fre- 
quently made in cows'-milk feeding, is that of 
giving the food too strong, at the beginning. 
In consequence, the digestive organs are over- 
taxed, the child vomits, has colic, suffers from 
constipation or diarrhoea, and, of course, can- 
not thrive; cows' milk is therefore discarded 
because it did not agree with the baby, while 
it was not the milk but the way it was given 
that was at fault. In the feeding formulas 
given below, the milk is adapted to the various 
ages of infancy and not to the child's condi- 
tion, as that would obviously be impossible. 



Artificial Feeding 63 

These formulas will be found suitable for 
average infants in fair health. In the matter 
of feeding, every child is a law unto himself 
and he must be fed individually. For some 
babies the formulas suggested will not answer 
at all. One six-months' child may require the 
nine-months' formula, while another may be 
able to take only the three-months' formula. 
All babies of the same age or weight must not 
be expected to thrive on food of exactly the 
same strength. 

It is the duty of the physician to adapt the 
milk to the patient's digestive capacity by giv- 
ing to each the required proportion of fat, 
proteids, and sugar. The signs of successful 
bottle-feeding are the same as of successful 
breast-feeding : comfort, sleep, and an aver- 
age gain in weight of not less than four ounces 
a week. There should be two or three yellow 
stools daily. 

Unsuccessful feeding. — The signs of unsuc- 
cessful feeding are vomiting, discomfort after 
feeding, habitual colic, green, undigested 
stools, and loss, or a very slight gain, in weight. 
A very few children cannot take cows' milk 
in any form. In this class belong those who 
have been badly managed. They have taken 



64 Artificial Feeding 

cows' milk too strong or otherwise improperly 
adapted. They may have undergone a series 
of hysterical changes with various proprietary 
meal foods in the hope that something might 
be found which would agree with them and on 
which they might thrive. 

In some cases cows' milk of any strength 
produces colic and vomiting or more often 
diarrhoea. These difficult feeding cases, 
whether the result of the delicate or peculiar 
condition of the child per se or of improper 
feeding, require the greatest patience on the 
part of the physician and mother. Many of 
these cases must be seen by the physician every 
day for weeks before they can be brought to 
take a suitable diet. - Milk in some must be 
temporarily discarded and substitutes, such as 
whey, diluted cream, barley water, broths, or 
malt soups, have to be used. After a short 
time a very small amount of milk may be added 
to the substitute which has been found best 
to agree. Should the milk again cause dis- 
turbance, condensed milk — one-half to one 
teaspoon ful — may be given with barley water, 
increasing the amount of condensed milk grad- 
ually if it is found to agree. A wet-nurse is 
almost indispensable in some of these cases. 



Food Formulas for Well Babies 65 

FOOD FORMULAS FOR WELL BABIES 

In using cows' milk for infant feeding the 
milk is allowed to stand in the quart bottle 
on the ice for five hours. 

The top 16 ounces are then dipped off with 
a one ounce cream dipper. (See Fig. 6.) If 
a dipper is not available the top 16 
ounces may be carefully poured out 
of the bottle. The poured off top 16 
ounces is the milk used until the 
third month; after this age larger 
amounts must be poured or dipped 
from the top. 

The following formulas are sug- 
gested for the various ages noted : 



FROM THE THIRD TO THE TENTH DAY ■ ^ 

Milk (top 16 oz.) 3 ounces 

Lime-water y 2 ounce THE 

Milk-sugar I ounce chapin 

Boiled water 16^ ounces 

Seven feedings in twenty-four hours ; 2 to 3 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 



66 Food Formulas for Well Babies 

FROM THE TENTH TO THE TWENTY-FIRST DAY 

Milk (top 16 oz.) 6 ounces 

Lime-water iy 2 ounces 

Milk-sugar i y 2 ounces 

Boiled water i6 l / 2 ounces 

Seven feedings in twenty-four hours; 2 to 3 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 

FROM THE THIRD TO THE SIXTH WEEK 

Milk (top 16 oz.) 10 ounces 

Lime-water 2 ounces 

Milk-sugar 2 ounces 

Boiled water 20 ounces 

Seven feedings in twenty-four hours; 3 to 4 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 

FROM THE SIXTH WEEK TO THE THIRD MONTH 

Milk (top 16 oz.) 14 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 18 ounces 

Seven feedings in twenty-four hours; 4 to 5 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 



Food Formulas for Well Babies 67 

FROM THE THIRD TO THE FIFTH MONTH 

Milk (top 18 oz.) 18 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 19 ounces 

Six feedings in twenty-four hours; 5 to 6 
ounces at three-hour intervals during the day 
and a feeding at 10 p.m. 

FROM THE FIFTH TO THE SEVENTH MONTH 

Milk (top 24 oz.) 24 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 15 ounces 

Five feedings in twenty-four hours; 6 to 7 
ounces at four-hour intervals, the last feeding at 
10 P.M. 

FROM THE SEVENTH TO THE NINTH MONTH 

Milk (whole) 28 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Barley water 14 ounces 

Five feedings in twenty-four hours; 7 to 9 
ounces at four-hour intervals, the last feeding at 

10 P.M. 



68 Food Formulas for Well Babies 

FROM THE NINTH TO THE TWELFTH MONTH 

Milk (whole) 32 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Barley water 10 ounces 

Five feedings in twenty-four hours; 8 to 9 
ounces at four-hour intervals, the last feeding at 
10 p.m. Nine ounces is the maximum amount that 
should be given a baby at one time. The feeding 
should be continuous. Re-warming milk that has 
been kept in the bottle is a very dangerous 
practice. If the entire contents of the bottle are 
not taken it may mean that the food is too strong, 
or that the interval between feedings needs to be 
lengthened. Twenty minutes is the usual time 
allowed for taking the bottle. 

Whole milk. — To obtain whole milk shake 
the bottle before use. 

Barley water. — Barley water is made by 
cooking 1 ounce of Robinson's or Cereo bar- 
ley flour in 1 pint of water for thirty minutes. 
Boiled water is added to replace the amount 
lost in boiling. The barley water should not 
be hot when added to the milk and lime-water. 
Milk-sugar may be dissolved in hot barley 
water. 



Food Formulas for Well Babies 69 

Keep the nursing bottles on the ice after they 
are filled. 

Convenient feeding hours are 6, 10, 2, 6, 
10 p.m. after 5 months of age. Strong vigor- 
ous infants may require stronger food than 
the above after the seventh month. 

Farina and cream of wheat. — It is not at all 
unusual for me to allow infants from the 
seventh to the ninth month a tablespoonful or 
two of farina or cream of wheat jelly (cooked 
two hours in water) before the 10 a.m. and 
6 p.m. feedings, with an ounce or two of the 
milk formula over it. 

Beef juice and dried bread. — Occasionally 
at this age, 2 or 3 teaspoonfuls of beef-juice 
mixed with bread-crumbs or a level tablespoon- 
ful of carrots, squash or spinach, are given 
before the 2 p.m. feeding. A piece of unsweet- 
ened zwieback or a crust of dried bread may be 
given after the bottle. 

Orange juice may be brought into use as 
soon as the 4-hour interval is instituted. 

One hour before the second feeding from 
one to three teaspoonfuls mixed with an equal 
quantity of water may be given. If the juice 
is at all tart a little sugar may be added. 

An advantage of the early spoon feeding of 



70 Food Formulas for Well Babies 

the cereals and vegetables, aside from its nutri- 
tional value rests in the fact that the child 
learns early to take food other than the bottle. 
It will be noticed that considerable latitude 
is allowed as to the amount of food which is 
to be given at one feeding. This is because 
of the difference in the capacity of individual 
children. After the third month the midnight 
feeding should be discontinued. Six feedings 
will be sufficient, the first at 6 a.m. and the 
last at 10 p.m. Between 10 p.m. and 6 a.m. 
the child should sleep. Babies are easily 
broken from the night bottle by substituting 
a bottle of boiled water or a milk mixture 
greatly diluted with water. The child soon 
discovers that this is not worth waking for. 
As a result of a full night's rest the digestive 
organs are better able to do their work, the 
appetite is increased, and a larger amount of 
food may be given at each feeding. 

Special adaptation. — The foregoing methods 
will be found useful for the majority of aver- 
age well babies. Those with pronounced diges- 
tive peculiarities should have the food especially 
adapted. 

When the milk does not agree the cause 
must be discovered. The food as a whole 



Feeding after the First Year 7 1 

may be too strong, when there will be indi- 
gestion and colic, and possibly diarrhoea and 
vomiting. If the food contains too much 
cream there will be looseness of the bowels, 
and colicky stools, with considerable straining; 
there is apt to be regurgitation also. An indi- 
cation of excess of sugar consists in the eruc- 
tation of gas and a regurgitation of sour, 
watery material. Diarrhoea may also be pro- 
duced by too high sugar. Excess of cows'- 
milk proteid (curd) may be the cause of 
habitual colic, and is an important element in 
habitual constipation. We sometimes see 
children who cannot take fresh cows' milk 
in any form. In these the milk must be 
cooked or one of the evaporated milks given. 

FEEDING AFTER THE FIRST YEAR 

At the completion of the twelfth month the 
average well-regulated baby should be weaned, 
and other nourishment given. The food suit- 
able for the second year of life and the method 
of its preparation and administration are sub- 
jects upon which the masses are most pro- 
foundly ignorant. A few children at this 
period of life are overfed, and carelessly given, 
at improper intervals, unsuitable food, wretch- 



7 2 Feeding after the First Year 

edly cooked. Summer diarrhoea finds its great- 
est number of victims among those children 
over twelve months of age who have been 
carelessly fed. The dreaded "second summer" 
robs many homes because of ignorant or care- 
less parents. The second summer managed 
properly is hardly more dangerous than any 
other summer during the early years of a 
child's life. It is almost a universal custom 
when the child is weaned or given something 
other than a milk diet to allow him "tastes" 
from the table. Very often these tastes com- 
prise the entire dietary of the adult. Milk is 
oftentimes the only suitable article of diet that 
is given. Afterward not only is the other food 
selected unsuitable, but it is given irregularly, 
and supplemented by crackers kept on hand 
for use between meals. During the hot 
months the gastro-intestinal tract is less able 
to bear such abuse and the child becomes ill. 
Usually when the twelfth month is completed 
I give the mother a diet schedule, with instruc- 
tions to begin gradually with the articles al- 
lowed, in order to test the child's ability to 
digest them. Every new article of food should 
be carefully prepared and given at first in very 
small quantities. All meals are to be given 



Feeding after the First Year 73 

regularly, with nothing between meals. With 
many children this expansion of the diet list 
is attended with considerable difficulty. They 
are thoroughly satisfied with the milk, and re- 
fuse all other forms of nourishment. In such 
cases time and patience are necessary at the 
feeding time. The more solid articles of diet 
should be given first, and the milk kept in the 
background. 

Among the underfed seen at this period of 
life are those who were nursed too long or 
those who were kept for too long a time upon 
an exclusive milk diet. A great majority of 
the cases of malnutrition of the second year 
are seen in the exclusively milk-fed. They 
are pale, soft, flabby, badly nourished children. 

The following is a diet schedule which I 
have employed for several years. Each mother 
is instructed to select, from the foods allowed, 
a suitable meal. 

From the twelfth to the fifteenth month: four 
meals daily. 
7 a.m. Two or three tablespoonfuls of 
cornmeal, oatmeal, wheatena, hominy, rice (all 
cooked four hours the day before in water), 
served with butter or milk and a little sugar. 



74 Feeding after the First Year 

Eight ounces milk from glass or bottle. Bread 
stuffs. 

9 a.m. Juice of one-half orange or three 
ounces prune juice. 

ii a.m. One tablespoonful of either scraped 
steak, minced chicken or minced chop, or soft 
boiled egg mixed with bread crumbs. Baked 
or mashed potato (medium size). Glass or bot- 
tle of milk. Bread stuffs. Sleep after this meal. 

2 130 p.m. Eight ounces chicken or mutton 
broth with bread or rice in it or eight ounces 
milk. One tablespoon stewed carrots, squash 
or spinach when broth is given. Desserts : 
Custard, cornstarch, junket. Bread stuffs. 

6 p.m. Two or three tablespoonfuls farina 
or cream of wheat (cooked two hours in 
water), or one of above cereals served as di- 
rected. Eight ounces milk from glass or 
bottle. Bread stuffs. Bread Stuffs : Wheats- 
worth biscuit. Zwieback or Holland Rusk. 
Toast. 

From the Fifteenth to eighteenth month: four 
meeds daily. 

7:30 a.m. Two or three tablespoonfuls 
cornmeal, oatmeal, wheatena, hominy, rice (all 
cooked four hours the day before in water), 



Feeding after the First Year 75 

served with butter or milk, with or without 
sugar. Glass of milk. Bread stuffs. 

9 a.m. Juice of one orange or three ounces 
prune juice. 

ii a.m. One tablespoonful scraped steak, 
minced chicken, minced chop, soft boiled egg 
mixed with bread crumbs. Baked or mashed 
potato. One tablespoonful spinach, aspara- 
gus, string beans, peas, squash, stewed carrots, 
stewed celery. Desserts : Stewed apples, 
stewed prunes, baked apple. No milk at this 
meal. Bread stuffs. Sleep after this meal. 

2 130 p.m. Eight ounces of chicken or mut- 
ton broth with bread or rice in it or eight 
ounces milk. Small cup of custard, cornstarch, 
or junket. Bread stuffs. 

6 p.m. Two or three tablespoonfuls farina 
or cream of wheat (cooked two hours in 
water) or one of above cereals served as di- 
rected. Glass of milk. Bread Stuffs : Wheats- 
worth biscuit. Zwieback or Holland Rusk. 
Dried bread. Plain white or whole wheat 
bread. 

From the eighteenth month to the third year: 
three meals daily. 

7:30 a.m. Two or three tablespoonfuls 
cornmeal, oatmeal, wheatena, hominy, or rice 



76 Feeding after the First Year 

(all cooked four hours the day before in 
water), served with butter or milk, with or 
without sugar. Glass of milk. Bread stuffs. 

9 a.m. Juice of one orange or three ounces 
prune juice. 

12 130 p.m. One or two tablespoonfuls 
scraped steak, chop or minced chicken or soft 
boiled tgg. Baked or mashed potato. One or 
two tablespoonfuls spinach, asparagus, string 
beans, peas, squash, white turnip, stewed car- 
rots, stewed celery or stewed onions. Des- 
serts : Stewed apple, stewed prunes, baked 
apple, rice, bread or tapioca pudding. Gela- 
tine pudding with lemon, vanilla or orange 
flavor. No milk at this meal. Bread stuffs. 
Rest one and one-half hours after this meal. 

4 p.m. Drink of milk and piece of toast or 
plain cracker. 

6 p.m. Two tablespoonfuls farina or cream 
of wheat (cooked two hours in water), or one 
of above cereals served as directed. Drink of 
milk or eight ounces of chicken or mutton 
broth. Spaghetti. Desserts : Custard, corn- 
starch, junket. Cream cheese or honey on 
bread or crackers. Bread Stuffs : Wheats- 
worth biscuit. Whole wheat bread. Plain 
bread. Zwieback. Holland Rusk. Toast. 



Feeding after the First Year 77 

From the third to the fifth year: three meals 
daily. 

7:30 a.m. Three to four tablespoonfuls 
cornmeal, oatmeal, wheatena, hominy or rice 
(all cooked four hours the day before in 
water) served with butter or milk, with or 
without sugar. One slice of bacon or soft 
boiled or poached egg. Cereal may be given 
with either bacon or egg, or egg may be given 
alone with milk and slice of bread and butter. 
Glass of milk. Bread stuffs. 

12:30 p.m. Steak, chop, minced chicken, 
baked or boiled halibut or cod fish. Baked or 
mashed potato. Two tablespoonfuls spinach, 
asparagus, string beans, peas, squash, white 
turnip, stewed carrots, stewed onions, mashed 
cauliflower. Desserts : Stewed apple, stewed 
prunes, baked apple, rice, bread or tapioca 
pudding. Gelatine pudding with orange, 
lemon or vanilla flavor. Stewed or raw 
peaches and cherries. All stewed fruits in 
season, excepting strawberries. Bread stuffs. 
Rest one and one-half hours after this meal. 

4 p.m. Scraped apple, pear or grapes. 

6 p.m. Three or four tablespoonfuls farina 
or cream of wheat (cooked two hours in 



78 Feeding after the First Year 

water) or one of above cereals, served as di- 
rected. Instead of cereal may have spaghetti. 
Glass of milk, or four ounces milk, four ounces 
water and one teaspoon Phillip's cocoa, with 
sugar, or eight ounces chicken or mutton broth. 
Custard, cornstarch, junket. Cream cheese 
or honey on bread or crackers. (Either milk, 
cocoa or soup may be given at night with the 
idea to variety. ) Bread Stuffs : Wheatsworth 
biscuits. Whole wheat bread. Plain bread. 
Zwieback. Holland Rusk. Toast. 

From the fifth to the seventh year: three meals 
daily. 

7:30 a.m. Three to four tablespoonfuls 
cornmeal, oatmeal, wheatena, hominy or rice 
(all cooked four hours the day before in 
water) served with butter or milk, either with 
or without sugar. Bacon, soft boiled, scram- 
bled or poached egg or minced chicken. Glass 
of milk. Bread stuffs. (The child will do 
best at this age if he is given more than a cereal 
and milk breakfast.) 

12 130 p.m. Steak, chop, roast beef, roast 
lamb, poultry, baked or boiled halibut or cod 
fish. Baked or mashed potato. Two table- 
spoonfuls spinach, asparagus, string beans, 



Feeding after the First Year 79 

peas, squash, white turnip, stewed carrots, 
stewed celery, stewed onions, mashed cauli- 
flower. Desserts : Stewed apple, stewed 
prunes, baked apple, rice, bread or tapioca 
pudding. Gelatine pudding with lemon, 
orange or vanilla flavor. Raw and stewed 
peaches and cherries. All stewed berries in 
season, except strawberries. Bread stuffs. 
Rest one and one-half hours after this meal. 

4 p.m. Raw apple, pear, grapes or banana. 

6 p.m. Three tablespoonfuls farina or cream 
of wheat (cooked two hours in water) or one 
of above cereals served as directed. Glass of 
milk or four ounces milk, four ounces water 
and one teaspoonful Phillip's cocoa, or eight 
ounces chicken or mutton broth. When broth 
is given stewed fruit to be given as dessert. In- 
stead of cereal may have spaghetti. Desserts : 
Custard, cornstarch, junket. Cream cheese 
or honey on bread or crackers. Bread Stuffs : 
Wheatsworth biscuit. Whole wheat bread. 
Plain bread. Zwieback. Holland Rusk. Toast. 

From the seventh to the eleventh year: three 
meals daily. 

7:30 a.m. Cornmeal, oatmeal, wheatena, 
hominy, rice (all cooked four hours the day 



80 Feeding after the First Year 

before in water) served with butter or milk, 
either with or without sugar. Occasionally a 
dried cereal may be given — shredded wheat, 
cornflakes, puffed rice or puffed wheat. Bacon, 
soft boiled, scrambled or poached egg, minced 
chicken or broiled fish. Glass of milk. Bread 
stuffs. 

12 130 p.m. Steak, chop, roast beef, roast 
lamb, poultry, baked or boiled halibut or cod 
fish. Baked or mashed potato. Spinach, 
asparagus, string beans, peas, squash, white 
turnip, stewed carrots, stewed celery, stewed 
onions, mashed cauliflower. Raw celery and 
lettuce. No milk at this meal. Desserts : 
Stewed apple, stewed prunes, baked apple, rice, 
bread or tapioca pudding. Gelatine pudding 
with orange, lemon or vanilla flavor. Raw 
and stewed peaches and cherries. All stewed 
berries in season, except strawberries. Bread 
stuffs. 

6 p.m. Farina or cream of wheat (cooked 
two hours in water) or one of above cereals 
served as directed. Glass of milk or cocoa. 
Chicken or mutton broth or dried pea or bean 
soup. When soup is given stewed fruit to 
be given as dessert. Instead of cereal may have 
spaghetti or baked potato or two to three table- 



Cooking of Vegetables 81 

spoonfuls of green vegetables. Desserts : 
Custard, cornstarch, junket. Cream cheese or 
honey on bread or crackers. Bread Stuffs : 
Wheatsworth biscuit. Whole wheat bread. 
Plain bread. Holland Rusk. Zwieback. 
Toast. 

COOKING OF VEGETABLES 

Select young tender vegetables, wash thor- 
oughly, cook in a small amount of water until 
they can readily be mashed with a fork. They 
should be mashed through a coarse sieve until 
the child is three years old. Then always mash 
with a fork. 

HOW THE CHILD SHOULD BE FED 

In the foregoing articles on feeding the 
author has endeavored to suggest the nature 
of the food required by the growing child, 
and the intervals at which food should be 
given. This, however, does not entirely cover 
the subject. A child should never dine with 
adults until he can have adult diet, if the cir- 
cumstances of the family will permit him to 
dine alone or with other children. It is a 
species of cruelty to expect a hungry child of 



82 How the Child Should be Fed 

tender age to sit at the table, see and smell the 
fragrant dishes, and be forced to content him- 
self without complaint with his restricted fare. 
The author recalls this custom as a cause of 
many tears, disputes, and fistic encounters with 
attendants, which formed no small part of the 
daily routine of his early life. 

In feeding, the spoon or fork must come in 
contact only with the food and the child's 
mouth; when not in use it should be allowed 
to rest on the clean table-cloth. If it falls to 
the floor by accident it should be dipped in 
boiling water before using it. Under no cir- 
cumstances should a feeding utensil be allowed 
to come in contact with the lips of the nurse 
or mother; time and again I have seen mothers 
and nurses sip or swallow the first teaspoonful 
of the food which is to be given, to determine 
if it is of the proper temperature. At other 
times, when the food is not particularly attrac- 
tive to the child, they will place the spoon in 
their mouths as though they intended to take 
it themselves. Others will remove from the 
spoon with their own lips adhering particles 
of food. 

There are few more reprehensible practices 
than the foregoing, and if parents knew the 



Condensed Milk (Sweetened) 83 

dangers to which their children are thus sub- 
jected they would not for one instant tolerate 
them. Any one of the many forms of patho- 
genic bacteria may be most readily transferred 
to the mouth of the child in this way. It is 
unquestionably a means of infection with 
tuberculosis, diphtheria, and syphilis. The 
germs of tuberculosis and diphtheria are fre- 
quently found in the mouths of perfectly 
healthy adults. They cause no symptoms of 
disease because of the normal power of resis- 
tance of such adults. The resisting powers of 
the child, however, to these micro-organisms 
are very slight, and when they are carried to 
the delicate mucous membrane of the infant's 
mouth and throat they thrive actively, the child 
develops diphtheria or tuberculosis, and the 
family grieve and wonder how the child could 
ever have contracted the disease. 

CONDENSED MILK (SWEETENED) 

Canned condensed milk, sweetened, should 
never be selected as a food for a baby if the 
mother can afford to buy cows' milk and can 
learn how to prepare and care for it. The 
child's natural food is the mother's milk; 



84 Condensed Milk (Sweetened) 

this is what he has a right to demand. If 
mothers' milk cannot be furnished we must 
give a substitute which will provide the baby 
with the nourishment contained in mothers' 
milk. Analyses by many chemists of thou- 
sands of samples of good mothers' milk show 
that it contains approximately 3.5 per cent, 
to 4 per cent, of fat, 1.5 per cent of proteid, 
and 7 per cent, of sugar. Condensed milk, 
diluted one to twelve, i.e., one part condensed 
milk to twelve parts of water, — the strength 
taken by a three-months-old child, — will give 
a food containing .5 per cent, of fat and .6 
per cent, of proteid, and 4 per cent, of sugar. 
Compare these figures with the amount of fat, 
sugar, and proteid contained in mothers' milk 
and it will readily be seen that the baby is not 
getting nearly as much nourishment as Nature 
would furnish him. If the mixture, using the 
condensed milk, is made in the proportion of 
one part condensed milk to eight parts of water 
— the proper strength for a six-months-old 
child — there will still be less than 1 per cent, of 
fat, and a lower proteid than in mothers' milk. 
Condensed milk has its uses, however. Many 
mothers cannot afford to buy fresh cows' milk. 
Some have no refrigerator or ice-box in which 



Condensed Milk (Sweetened) 85 

to keep it. Condensed milk, on account of the 
cane sugar which has been added to it, will 
remain fresh for two or three days after it has 
been opened. It is a most inexpensive means 
of feeding the baby. Further, its prepara- 
tion is exceedingly simple, and many mothers 
are too ignorant to appreciate the importance 
of the careful preparation of cows' milk. 

Condensed milk is for many an absolute 
necessity; but though children manage to live 
on it, they never thrive satisfactorily. They 
all show evidence of some degree of rickets, 
unless fat in some form, e.g., cod-liver oil or 
cream, is given in addition, to supplement the 
food : and very few children can take cod-liver 
oil during the summer months. There is an- 
other class of children for whom condensed 
milk has served us well at various times. They 
are the young, delicate infants, with very weak 
digestive powers. Their mothers cannot nurse 
them, wet-nurses are impossible, and, for some 
reason, the smallest amount of cows' milk, 
most carefully adapted, cannot be tolerated; a 
single teaspoonful of milk or cream in two 
ounces of plain water, whey, weak milk-sugar 
water, or barley water produces colic and 
diarrhoea. I have successfully fed several of 



86 Condensed Milk (Sweetened) 

these infants on a mixture consisting of one 
part of condensed milk and twelve parts of 
water. I prefer the unsweetened variety. For 
some unexplained reason these children digest 
the condensed milk without any inconvenience 
and do fairly well for a few weeks, when the 
secretion of the digestive juices will be better 
established and a weak adapted cows'-milk 
mixture will be borne. Condensed milk is 
also useful in travelling. During journeys by 
land and sea, condensed milk with boiled water 
will furnish satisfactory food for a limited 
time at a minimum amount of trouble. 

The following formulae may be found of 
service to those who for any reason are forced 
to use a temporary substitute for adapted 
cows' milk: 

First month of life: I part of condensed milk 
to 16 of water. 

Second month: I part of condensed milk to 
14 of water. 

Third month: 1 part of condensed milk to 12 
of water. 

Fourth to sixth month: 1 part of condensed 
milk to 10 of water. 

After the sixth month: 1 part of condensed 
milk to from 8 to 10 of water. 



The Proprietary Foods 87 

Condensed milk, unsweetened: In the un- 
sweetened condensed milk known on the 
market as evaporated milk, we have a very 
helpful means in the feeding of many delicate 
infants. Through the processes of evapora- 
tion the milk is made easier of assimilation 
by the child. It is used after the fashion of 
fresh cows' milk through the addition of 
water, sugar, barley, lime-water, etc. One 
ounce represents 2 and two-fifths ounces of 
fresh cows' milk. This concentration has to be 
considered in arranging the formula. 

THE PROPRIETARY FOODS 

The foods on the market prepared for pur- 
poses of infant feeding are almost without 
number. From our knowledge of the com- 
position of mothers' milk we learn what nu- 
tritional elements and approximately in what 
relative proportions these elements must exist 
in order to supply the child with the food 
which Nature intended him to have. The ex- 
amination of the milk of thousands of nursing 
women shows that it ranges from 2.5 to 4 per 
cent, fat, 6 to 7 per cent, sugar, and 1 to 1.5 
per cent, proteid. These figures may be put 
down as the normal limits of human milk, and 



88 The Proprietary Foods 

they are so, simply because the infant will 
thrive and grow when the nutritional elements 
in approximately the above proportions are 
supplied to him. It is within these limits that 
the food must be kept in order that there may 
be normal growth and development ; though of 
course, wide variations from these may be of 
temporary occurrence. While the child may 
exist and temporarily do fairly well on a per- 
centage of fat lower than 2.5, he will invariably 
show defective growth if the proteid 
remains persistently under 1 per cent. The 
chief disadvantage in the infant foods which 
are used without the addition of cows' milk, 
lies in the fact that they do not contain the 
nutritional elements as they exist in normal 
breast-milk, and besides, of necessity, they are 
all cooked foods. 

In selecting a substitute for mothers' milk 
one point is to be kept in mind, viz., the sub- 
stitute should contain, in a readily assimilable 
form, the nutritional elements in approxi- 
mately the proportions and forms in which 
they exist in mothers' milk. All other feeding 
is defective. It is not well to put too much 
reliance on the analysis sometimes published 
by the proprietary food manufacturer. This 



The Proprietary Foods 89 

type of food is decidedly weak in animal fat, 
for the reason that there is no means of keep- 
ing more than a small percentage of it in 
a food without its becoming rancid. When 
considerable percentages are indicated in the 
analysis it is certain that it does not consist 
of butter fat. The quantity of animal milk 
proteid is likewise deficient. Scurvy is not 
an infrequent result of the exclusive use of 
these foods. 

The uses of proprietary dried-milk foods. 
— It is to be remembered that this type of 
food is condemned because of its being an 
unsuitable food when used exclusively and 
persistently. In constipation in "runabout" 
and older children who are on a general diet, 
the importance of milk in the nutrition is a 
secondary one, and is often an important fac- 
tor in the production of constipation. In these 
cases cows' milk may be replaced by one of the 
proprietary dried-milk foods which has a laxa- 
tive effect, with a good deal of advantage. I 
sometimes employ them further in other dis- 
ordered states. During acute illness and in 
convalescence from illness and in certain forms 
of malnutrition they are usually readily di- 
gested and may help us over difficult places. 



90 The Proprietary Foods 

Proprietary foods to which fresh cows' milk 
is added. — These are not foods in the usual ac- 
ceptation of the term, and if they are used 
alone independent of milk the patient will soon 
present a sorry spectacle. They are sugars 
largely, being composed of maltose and dex- 
trin, which are derived from starch. Some 
contain a considerable quantity of unconverted 
starch. When added to the water and milk 
mixtures they furnish the soluble carbohy- 
drates in the form of maltose and free starch, 
and thus fulfill this function in the food with 
as good results as, but usually no better than, 
would milk-sugar and a cereal gruel. Maltose 
is a laxative sugar. In case of constipation in 
the bottle-fed it may replace the milk-sugar in 
equal quantity, and as such may be used with 
decided advantage in some cases. In others, 
this change to maltose is without effect. The 
claim that when added to cows' milk these 
proprietary foods increase the liability to 
scurvy is without foundation. If the milk is 
given uncooked, the child will not have scurvy, 
regardless of the nature of the sugar; if the 
milk is heated to 160 or I70°F., the child 
may have scurvy regardless of the sugar. 

According to my observation, the statement 



The Proprietary Foods 91 

that the addition of maltose to cows' milk 
facilitates its digestion is unfounded. I have 
tried it in many cases, but have never been 
able in consequence to use a stronger cows'- 
milk mixture. The true test of such a measure 
is its use in the delicate and in difficult feeding 
cases, and not in well babies who thrive regard- 
less of the sugar employed. The maltose 
preparations, then, in the sense that they may 
contain a small amount of proteid and a laxa- 
tive sugar, are useful and to be recommended 
when such a carbohydrate is needed. 

The proprietary beef foods. — Numerous 
preparations of this nature are on the market 
and there has been abundant opportunity to 
test their value. Without going into a lengthy 
discussion as to how and under what condi- 
tions these preparations have been used, it is 
sufficient to say that as a means of nutrition 
in children they play a very unimportant part. 
Their principal use is in illness, in which they 
act as a stimulant, and to a less degree as a 
food. They all make weak proteid mixtures 
when diluted so that the child can take them. 
The possibility of supplying any great amount 
of nutrition to the economy by their use is 
small ; occasionally, however, they may be used 



92 Milk for Travelling 

to advantage. When milk is withdrawn they 
may be added to the cereal gruel substitute. If 
there is diarrhoea, great care must be exercised, 
as the proprietary beef preparations as well 
as beef-juice may increase it. On account of 
the creatinin which they, contain, they should 
not be given in any of the forms of nephritis. 
Another feature which limits their use is that 
a child soon tires of them. They can rarely be 
given more than two or three times in twenty- 
four hours. Valentine's is the preparation I 
usually select. It may be given in solution — 
one-quarter to one-half teaspoonful to six 
ounces of the diluent. 

MILK FOR TRAVELLING 

In making long journeys with infants by 
land or water, the feeding of the child is an 
important matter, and advice is often sought 
by mothers who wish to make the contem- 
plated trip with the least possible risk. It is, 
of course, desirable that no change be made in 
the milk commonly used, and there are means 
of treating the milk and of keeping it which 
enables us to assure the patient of reasonable 
safety. It is my custom with city children to 



Milk for Travelling 93 

have the milk prepared at the Walker-Gordon 
Laboratory, where at a trifling expense small 
ice-boxes can be obtained which contain suffi- 
cient space for a few days' supply of milk and 
which can be conveniently carried on cars and 
boats. They have also larger boxes with a 
capacity of twelve quarts, which may be used 
for an ocean voyage. The smaller box will 
need refilling with ice once or twice a day, 
which is usually readily secured. The larger 
box, for ocean voyages, is packed in ice and 
placed in a cold-storage room of the vessel and 
will not need repacking during the trip. Labo- 
ratory milk, however, is available for com- 
paratively few. 

Milk prepared at home for a journey should 
be cooled to 45 F. as soon as it is drawn, and 
kept at this temperature until it can be ster- 
ilized at a temperature of 212 F. for twenty 
minutes. It then should be cooled rapidly to 
at least 50 F. and kept at this point until used. 
These directions can be carried out by any 
intelligent family. When this is done the milk 
will be safe for use for the time required — 
from seven to eight days. Even the sugges- 
tions as to the making of an ice-box can be 
followed in any town or village. All that is 



94 Diet During Illness 

required is the ice-box, one-quart fruit jars 
or one-quart milk bottles, and clean milk. 
Those who for any reason cannot avail them- 
selves of the milk thus preserved will find in 
canned condensed milk a fairly good substitute. 
If kept on ice and wrapped in a clean towel, a 
can of condensed milk may safely be used for 
three days after opening. Formulas suited for 
the various months of infancy will be found 
in the section on condensed milk (page 86). 

DIET DURING ILLNESS 

The digestive capacity of every child is 
diminished during illness, depending largely 
upon the age of the child and the severity of 
the disease. The younger the child, the greater 
the incapacity. This is fairly constant with 
all the ailments of childhood, including, of 
course, those which directly affect the gastro- 
enteric tract. In a moderately severe bron- 
chitis, with a degree or two of fever, the 
digestive capacity is slightly diminished and a 
25 per cent, reduction in the strength of the 
food will answer. During the critical stage of 
a lobar pneumonia the digestive powers are 
held in abeyance and predigested foods and 



Diet During Illness 95 

alcohol must sustain the patient. During an 
attack of measles, scarlet fever, broncho- 
pneumonia, or diphtheria in bottle-fed infants, 
at the height of the disease, it is my custom to 
reduce the strength of the food one-half by 
the addition of water, to make up for the quan- 
tity removed. For ailments of lesser severity, 
such as bronchitis, with a temperature of ioo° 
to ioi° F., or chicken-pox, or mild measles, I 
reduce the strength of the food from one- 
fourth to one-third. In any mild ailment or 
injury which confines a child to its bed, the 
food strength should be cut down, for inactivity 
as well as disease lessens the digestive capacity. 
Among nurslings and the bottle-fed these 
precautions are particularly necessary. A 
child with fever is apt to be thirsty and to take 
more food than in health. This is frequently 
the case in summer diarrhoea. In order to 
avoid this taking of too much food, I not only 
order the milk to be diluted for the bottle-fed 
but I instruct the mothers of nurslings to give 
a drink of water immediately before each 
nursing and between nursings, and then to al- 
low the child to nurse only one-half or two- 
thirds the usual time. For the bottle-fed, one- 
half to two-thirds of the contents of each bottle 



96 Diet During Illness 

is removed and the quantity replaced by boiled 
water, so that the amount of fluid given re- 
mains the same. 

If the child is a "runabout," over two years 
of age, he is given broths and thin gruel — one- 
half milk and one-half gruel. By carefully 
watching the stools, thus fitting the food to 
the child's capacity, we will avoid grave intes- 
tinal complications which, during the summer, 
often prove to be more serious than the original 
ailment. In the acute gastro-enteric troubles, 
and in typhoid fever, all milk must be discon- 
tinued. 

The art of feeding in illness. — Not only is 
food oftentimes taken in insufficient quantity 
in illness, but in many cases it is absolutely re- 
fused. In ether cases, during coma and 
asthenic states, swallowing is impossible. In 
delirium and in conditions of collapse nourish- 
ment must be given, and when this is impossi- 
ble by the natural method, we have, as tem- 
porary substitutes, gavage, oil inunctions, and 
rectal feeding — all of which must be prescribed 
by the attending physician to suit the individual 
case. 

Forced feeding. — Forcing the child to take 
nourishment by the mouth is rarely necessary. 



Diet During Illness 97 

Coaxing and bribing ordinarily succeed far 
better. For a child from three to five years 
of age a bright new penny possesses much 
persuasive power. The child will usually 
take its food better from those to whom it is 
accustomed, like the mother or nursery-maid. 
The trained nurse should understand that 
while unacquainted with the patient, the 
simpler requirements of the child are to be 
looked after by others to whom the patient 
is accustomed. The nourishment should be 
as palatable as possible and served in bowls, 
cups, or plates that are attractive to the 
patient because of color, pictures, or pecu- 
liarities of shape. Junket, flavored with 
vanilla, served cold is a favorite food for 
sick children of the "runabout" age. Frozen 
custard, and home-made ice-cream, made with 
one-third cream and two-thirds milk, will 
usually be well taken. Toast, dry bread, and 
crackers made in peculiar shapes are attractive 
to the child. In not a few cases I have suc- 
ceeded in feeding satisfactorily children two 
or three years old, when several other schemes 
had failed, by allowing the temporary return to 
the bottle, from which they had been weaned 
for a year or so. 



98 Vomiting 

In these difficult feeding cases the child's 
peculiarities and wishes must be studied. 
Children in illness require water. Oftentimes 
they will take it in insufficient quantities. 
Those who refuse plain water will often take 
ginger ale, sarsaparilla, or vichy. In the event 
of these drinks being well taken, they may be 
given freely. In the acute infectious diseases, 
which include pneumonia, free water-drinking 
is a therapeutic measure of no mean value. 

VOMITING 

A sudden attack of vomiting, with fever, 
may usher in any serious illness. Thus, it 
may be the initial symptom of pneumonia, 
scarlet fever, or meningitis. By far the most 
usual cause, however, will be found intimately 
connected with the stomach, usually an acute 
attack of indigestion. Bottle-fed children 
furnish the greatest number of patients, as 
these children are often overfed. 

Management. — With the onset of a sharp 
attack of vomiting, particularly if it occurs 
during hot weather, the milk diet should im- 
mediately be discontinued. Small quantities of 
boiled water, one-half to two ounces of barley 



Habitual Vomiting 99 

water, or rice water, or plain broths may be 
given every hour or two. In the obstinate 
cases, quite a period of rest should be given to 
the stomach. From twenty-four to thirty-six 
hours will often be necessary before the child 
will be able to retain even a teaspoonful of 
water. One teaspoonful of bicarbonate of 
soda added to one glass of quite hot water will 
often be retained if given in small quantities — 
one teaspoonful every few minutes. No milk 
should be given until the vomiting has ceased 
for at least two days. When the milk is re- 
sumed it should be diluted two or three times 
with water or barley water and at first only 
a small quantity of the mixture given. If the 
stomach bears the food well its strength may 
gradually be increased by an additional half- 
ounce or ounce of milk to each feeding daily, 
until the former diet is resumed. 



HABITUAL VOMITING 

Many infants regurgitate or vomit a por- 
tion of every feeding. This usually means the 
child has been or is overfed. He is given the 
food too strong, too much sugar or fat, or the 
amount is greater than his capacity, or he is 



ioo Habitual Vomiting 

fed at too frequent intervals. In either case 
the stomach relieves itself. Many of these 
children who regurgitate after each feeding 
thrive finely in spite of the loss. Enough is 
retained for their nourishment, and they grad- 
ually become accustomed to the strong food 
and no serious harm results. Such a stomach, 
however, is liable to behave very badly during 
hot weather. During any illness, in fact, 
which taxes the patient's strength, the dis- 
ordered stomach stands ready to furnish an 
unpleasant complication. 

Habitual vomiting occurs also in infants in 
whom there is an obstruction at the outlet of 
the stomach. The condition may be one of 
simple spasm of the parts or there may be a 
muscular growth which resists the passage of 
food into the intestines. A condition known 
as rumination explains habitual vomiting in 
a few infants. In such cases the child volun- 
tarily forces the food from the stomach into 
the mouth, a portion is reswallowed but the 
greater is regurgitated. 

All cases of habitual vomiting, particularly 
if there is loss in weight, should be brought to 
the attention of the physician. 

Management. — The treatment of ordinary 



Malnutrition and Marasmus 101 

habitual vomiting in the bottle-fed is by a suit- 
able adaptation of the food, usually by cutting- 
down the fat and sugar and by stomach wash- 
ing. Among the breast-fed the breast-milk 
will have to be examined and, if found unsuit- 
able, corrected if possible. If too frequent 
nursings or night nursings have been allowed 
they should be discontinued. The abdominal 
binder should never be tightly applied in vomit- 
ing babies. 

MALNUTRITION AND MARASMUS 

By malnutrition we understand that con- 
dition in which a child for some reason fails 
to gain in weight or loses steadily for a con- 
siderable period of time. Cases present all 
degrees of severity, from those in which there 
is merely a temporary loss of weight, to those 
of an extreme degree of malnutrition, which 
latter condition we term marasmus. A ma- 
rasmatic infant presents one of the most piti- 
ful pictures we are called to look upon : the 
dry skin drawn tightly over the fleshless bones, 
the sunken eye, the distended abdomen, the 
anxious, tired expression, and the whining cry 
furnish a picture of starvation so pathetic that 



102 Malnutrition and Marasmus 

only those hardened by long familiarity with 
such cases can look upon them unmoved. 

Causes of marasmus. — When the history of 
such infants has been looked into it will be 
learned that errors in feeding contributed 
largely to bringing them to their woeful 
condition. Many of these children came into 
the world strong and vigorous, the mothers 
were unable to nurse them, and the food 
selected did not agree with them. Cows' milk, 
perhaps, was given, unsuitably adapted, — 
it usually is given too strong to young infants, 
— at any rate it disagreed, and the proprietary 
meal foods were brought into use, one after 
another, as they were suggested by well-mean- 
ing friends, each to do its share of damage and 
in turn to be discarded. The digestive organs 
bore the ill-usage for a time, but soon became 
so disturbed that the utilization of rational 
food was out of the question. Many of these 
children finally reach the point where predi- 
gested foods fail to be assimilated; such cases, 
of course, are hopeless. 

Lay advice. — It is a source of amusement 
oftentimes to note the assurance with which 
laymen will advise a mother that such and 
such a food is the only one for the baby, when 



Malnutrition and Marasmus 103 

they possess neither the intelligence nor the 
training necessary to judge of the child's di- 
gestive peculiarities or capacity; in fact, they 
know no more of the child's requirements or 
the chemical composition of the food sug- 
gested, or even what should be the composi- 
tion of the baby's food, than does the 
unfortunate babe itself. 

Outcome of the cases. — If there is inherited 
weakness, or a low vitality from any cause, 
the downward course may be very rapid. 
There are two or three weeks of suffering, 
and then the end. If seen before the vital 
powers are at too low an ebb, these children, 
by very careful and intelligent management, 
can be saved. 

Management. — They should be handled 
only when necessary for dressing and bathing. 
The nourishment given must at first be very 
weak, and its effects carefully watched from 
day to day, the strength and amount of the 
food being increased or decreased, as may be 
found necessary by the physician. A brine 
bath should be given daily, — a tablespoonful 
of salt to a gallon of water. The temperature 
of the water should be ioo° to 105 F. The 
child should remain in the water ten minutes, 



104 Malnutrition and Marasmus 

being rubbed well with the hand while in the 
water. When removed, it should be placed 
in a large bath towel and dried quickly. — 
When dry, rub one tablespoonful of unsalted 
lard or goose-grease into the skin. Flannel 
should be worn next to the skin except during 
very warm summer weather. 

Excessive attention is bad for these infants. 
They should be kept very quiet between the 
necessary feedings and bathing. 

Marasmatic children when sleeping should 
not be allowed to remain long in one position; 
they should frequently be turned from the 
back to the side, and from one side to the 
other. A hot-water bottle to the feet will often 
be necessary when sleeping. 

Airing. — To a child suffering from malnu- 
trition, fresh aid is as indispensable as food. 
During the warm weather if he can be pro- 
tected from the sun the child should be kept 
out of doors from morning until night. Dur- 
ing the entire year he should sleep with the 
window open. During the winter months he 
should be taken out of doors for at least two 
hours every pleasant day. When, on account 
of the inclement weather or excessive cold, 
he cannot go out, he should be dressed as for 



Summer Diarrhoea 105 

the daily outing, taken into a room all the win- 
dows of which have been open for at least one- 
half hour; here, placed in a baby-carriage and 
warmly covered, with a hot-water bottle at his 
feet, he is allowed to enjoy the fresh air for 
several hours each day. This brightens the eye, 
brings color to the cheek, and an invigorated 
baby returns to the nursery. 

SUMMER DIARRHOEA 

Summer diarrhoea is the cause of more 
deaths among young children in our large 
cities than any other one factor. 

Nature of summer diarrhoea. — Every illness 
of this nature must be considered as a case of 
poisoning. The vomiting and diarrhoea are 
conservative efforts on the part of the organ- 
ism to get rid of the offending material. The 
poisoning may result from direct infection. 
It may be due to bacteria-laden milk, unclean 
feeding apparatus, or to any means whereby 
poisonous germs find entrance into the gastro- 
intestinal tract. 

There may also be an indirect infection or 
self-poisoning — an auto-intoxication. Heat 
plays an important part in these cases. The 



106 Summer Diarrhoea 

child is greatly depressed; the digestive proc- 
esses are not properly carried on — the milk 
taken from the breast or bottle is not acted 
upon by digestive juices of the usual strength 
and volume; decomposition takes place; 
poisons are generated and absorbed, producing 
fever and prostration, the intestine endeavors 
to empty itself of the offending material and 
diarrhoea results. 

Cholera infantum, inflammation of the 
bowels, dysentery — all very bad terms but in 
common use — are due primarily to the causes 
above mentioned. 

Management. — Such being the nature of 
summer diarrhoea, the duties of the mother 
in such cases should be clearly understood. 
The intestine must be relieved of as much as 
possible of the material which is causing the 
trouble. For this purpose give two tea- 
spoonfuls of castor-oil, and nourishment which 
will not furnish a fertile soil for the growth 
of bacteria. For this reason milk must be 
stopped with the first symptom of the trouble. 
The mother will never make a mistake in 
these cases; in fact, many a life will be saved 
by an immediate dose of castor-oil and by 
promptly stopping the milk diet before the 



Summer Diarrhoea 107 

physician who must always be called arrives. 
Milk, in addition to furnishing a medium for 
the growth of bacteria, forms into tough curds 
which must pass the entire length of the intes- 
tinal tract, exciting a very active peristalsis, 
causing pain and an increase in the number of 
passages. 

Milk substitutes. — The diet substituted for 
milk should consist of some cereal water; 
either barley, wheat, or rice may thus be used ; 
chicken or mutton broth, whey, or substances 
of like nature may be given alternately or 
combined with the cereal waters. Salt should 
be added to the barley water if it is given plain. 
I prefer to give one or two ounces of chicken 
broth or mutton broth with the barley water. 
A teaspoonful of sherry wine or one teaspoon- 
ful of liquid peptonoids may be added to the 
barley water. Broths must be given in small 
amounts, as not infrequently they have a de- 
cidedly laxative effect. 

It is not advisable to give one food con- 
tinuously, as the child will tire of it. The 
addition to the barley water of one of the sub- 
stances suggested will so change its taste that, 
if necessary, the diet may be continued for 
several days. The quantity should correspond 



108 Summer Diarrhoea 

to the amount of food taken in health, but the 
intervals between feedings should be shorter — 
every two hours if practicable. For instruc- 
tions for cooking the cereal water, see For- 
mula, page 315. 

How milk is to be resumed. — A patient is 
not to be considered out of danger nor should 
the milk diet be resumed until the stools are 
normal and not over two or three daily. In 
many cases milk must be excluded for two or 
three weeks. When it is resumed, care must 
be exercised in not giving too strong a mix- 
ture; many a relapse is due to this error. The 
first day not over one-quarter ounce of milk 
should be given in each feeding of the barley 
water. If this causes no disturbance one-half 
ounce may be given the next day, increasing 
from one-quarter to one-half ounce daily, if 
there is no return of the diarrhoea, until the 
customary strength is reached. Many children 
will not be able to digest nearly as strong a 
mixture as they were taking before their ill- 
ness, and the diluted milk mixture will have 
to be supplemented by the use of dextrinized 
cereal gruels, cereal jellies, scraped beef, the 
white of an egg, and other easily digested sub- 
stances. Every year I have patients who, after 



Summer Diarrhoea 109 

an attack of diarrhoea cannot take a particle 
of milk without harm until the autumn is well 
advanced. 

Protein Milk and Lactic Protein Milk and 
Lactic Acid Milk are preparations of milk of 
different strengths that have been treated with 
the Bulgarian bacillus. They are exceeding 
useful in summer diarrhoea but should be pre- 
scribed by the attending physician. Milk so 
prepared may be given freely and earlier in 
the disease which makes them very desirable 
means of supplying nourishment at a critical 
time. 

Bowel irrigation. — Washing out the bowels 
once or twice a day is also very helpful in the 
treatment of these cases if the stools contain 
any blood or much mucus. This is done as 
follows: A No. 14 soft-rubber English cathe- 
ter, one that will not bend upon itself, if 
properly used, is attached to a fountain 
syringe. The bag should be held three feet 
above the patient, who should lie on the left 
side with the legs well drawn up. The tip of 
the well-oiled catheter is passed into the rec- 
tum a distance of two inches, w r hen the water 
is allowed to pass in slowly. The w r ater will 
distend the parts and facilitate the further in- 



no Summer Diarrhoea 

troduction of the tube. Press the folds of the 
buttocks together until the colon is filled. This, 
in a child eighteen months of age, will require 
from twenty-four to thirty ounces of water. 
When not less than one pint has passed in 
allow the water to pass out alongside the 
tube. 

Prevention. — A word regarding the pre- 
vention of summer diarrhcea. It is not enough 
that the child be given properly prepared pas- 
teurized or sterilized milk or breast-milk, — he 
must be made comfortable during the hot 
weather. The clothing should be of the light- 
est. On very hot days, if in the country, he 
should be kept in the open air, in the shade; 
if in the city, the coolest room in a house or 
an apartment is far better than the dusty 
streets. Whether in the city or country, on 
very hot days two or three fifteen-minute 
spongings with water at 6o° F. will add 
greatly to the child's comfort. 

Reduction of food. — Further, we know that 
the digestive capacity is lessened during the 
heated term, and the milk should be reduced 
in strength from one-quarter to one-third, 
adding boiled water to take the place of the 
milk removed. 



Baths in 

Cleanliness. — As infection may be carried 
to the feeding utensils by the hands of the 
nurse or mother, she should always wash them 
most carefully with soap and water before 
handling bottles or nipples, or preparing the 
infant's food. Inasmuch as other children 
may become infected, or reinfection take place 
in the one already ill, a child with summer 
diarrhoea should be isolated. 

BATHS 

The newly born child should be given daily 
a basin-bath with lukewarm, boiled water and 
castile soap until the cord falls and the navel 
heals. When this has taken place the tub- 
bath may be given. The temperature of the 
bath for the very young infant should not be 
below 95° F. nor above ioo° F. Very young 
children should not be kept in the water more 
than three minutes. After the third or fourth 
month a temperature of 90 or 95 F. is best, 
the child being kept in the water about five 
minutes. At this age I prefer to have the tub- 
bath given at night, just before the child is 
put to bed. A basin-bath may be given in the 
morning. When the child is a year old and 



ii2 Baths 

fairly vigorous, the temperature of the water 
at the beginning of the bath should be 90 F. 
This should gradually be reduced to 8o° F. by 
the addition of cold water, the child being 
vigorously rubbed with the hand while in the 
water. The temperature of the room should 
be from 76 to 8o° F. during the bath, and 
windows and doors should be closed. When 
removed from the tub the baby should be dried 
quickly and thoroughly, and the folds of the 
skin should be well powdered. A sponge 
should never be used in any portion of the 
bathing process. It should never be included 
in the nursery outfit. It is never clean after 
it has once been used. 

Dread of the bath. — Some children have a 
dread of the bath, and cry frantically when 
placed in the water. This is due to fear, and 
may usually be overcome by placing a sheet 
over the tub and lowering the child on it into 
the water. 

The cold douche. — For "runabouts" from 
two to three years old it may not be wise to 
use water below 70 F., but many patients 
over three years have the water applied in the 
form of a cold douche after the cleansing bath, 
during the entire twelve months at the tempera- 



Baths 113 

ture at which it runs from the faucet. In 
winter, in New York houses, this ranges from 
50 to 6o° F. 

In giving the cold douche the child should 
stand in warm water covering the ankles. The 
douche may be used in the form of a spray 
or shower or the water may be applied by 
means of a sponge moistened with it at the 
desired temperature. The head, if the shower 
or spray is used, should be suitably protected 
by an oil-skin or rubber bathing cap. 

After the cold douche there should be a 
vigorous friction of the skin with a rough 
towel. If there is not a quick reaction, if the 
skin does not become warm and glowing, 
warmer water should be used. So also with 
blueness of the extremities and "goose flesh"; 
use water less cold, but do not discontinue the 
douche. 

In the great majority of homes the bathing 
of the children can be carried on with greater 
convenience immediately before their bed- 
time. The child should receive the warm bath 
and the cold douche, and then, in night-clothes, 
a warm wrapper, and suitable foot covering, he 
should have his supper. However, if this time 
is not convenient, he may be given the evening 



ii4 Baths 

meal at 5 130 or 6 130, followed in one hour 
by the bath and bed. 

Tub-baths for fever. — Place the child in 
water at a temperature of 95 ° F. and reduce 
to 75 or 8o° F. by the addition of ice or 
cold water. The duration of the bath should 
not be more than ten minutes, constant fric- 
tion being maintained during the entire proc- 
ess. 

Basin bathing for fever. — Add eight ounces 
of alcohol to a quart of water at a tempera- 
ture of 70 F. The child is stripped and 
covered with a flannel blanket, and the entire 
body sponged with this solution for ten or 
fifteen minutes. 

Either the tub-bath or the basin-bath may 
be used by the mother in case of sudden high 
fever — 104 to 105 F. — before the physician 
arrives. She should be so instructed. 

Bathing for comfort in hot weather. — The 
basin-bath and tub-bath may also be used as 
a means of relief during very hot weather. 
One or two basin-baths a day, with, a tub- 
bath at bedtime during this trying season, will 
give the child much relief, and help him to 
pass safely through it. The very young feel 
the extreme heat most acutely, and endure it 



Baths 115 

with difficulty. I know of nothing else that 
will give a restless, uncomfortable, heat-tor- 
mented child such a refreshing sleep as will 
a cool basin-bath. 

Mustard bath. — A mustard bath is prepared 
by adding a heaping tablespoonful of mustard 
to six gallons of warm water. The mustard 
should be placed in a small muslin bag and 
placed in the water. One of the uses of the 
mustard bath is in the treatment of convul- 
sions; it will be found useful also for nervous 
children who sleep badly. Two or three min- 
utes in the mustard water, followed by a quick 
rubbing immediately before going to bed, is 
oftentimes all that will be required to induce 
refreshing sleep. 

Brine bath. — A brine bath — an even table- 
spoonful of salt to one gallon of water — is of 
great service with very delicate, poorly 
nourished children. Its action is that 
of a tonic. If the child is thoroughly 
soaped and washed with plain water, and 
then immersed in the brine bath, no further 
tubbing is necessary. The child should be 
kept in the bath for five or ten minutes, 
constant friction being continued during the 
entire time. 



n6 Baths 

Soda bath. — The soda bath is of some ser- 
vice in cases of prickly heat from which many 
children suffer during the summer. A table- 
spoonful of bicarbonate of soda should be 
added to each half -gallon of water used. The 
temperature of the water should be that to 
which the child is accustomed. From two to 
four minutes in the water suffices. There 
should be little or no friction of the skin. The 
child should be dried with soft towels. 

Bran bath. — The bran bath also is of ser- 
vice in prickly heat. One cup of bran is 
mixed with the water in the bath-tub and 
the same method employed as for the soda 
bath. 

Starch bath. — The starch bath also is useful 
in prickly heat. One-half cupful of powdered 
laundry starch is mixed with the water in the 
bath-tub, and the same method employed as 
for the soda bath. 

Hot bath. — Place the child for from three 
to five minutes in water which has been raised 
to a temperature of 105 to no°F. Con- 
stant friction of the extremities is maintained 
while in the water. Upon removing the child 
from the water wrap him quickly in a warm 
blanket and put him in a warm bed. 



Earache 117 

EARACHE 

Infants and young children are very sus- 
ceptible to attacks of earache. They usually 
occur in children who are suffering from some 
inflammatory condition of the throat or nose. 
Such, however, is not necessarily the case. I 
have seen earache in children who apparently 
were in perfect health. In the very young the 
only symptoms of the trouble may be restless- 
ness, fever, which is usually present, and pain, 
which is manifested by crying. I have re- 
peatedly seen an attack so severe as to cause 
an infant to shriek with pain, without any sign 
to locate the trouble. An older child, in addi- 
tion to the above, will usually raise the hand to 
the side affected or point to the painful ear. 
The child usually is much disturbed if the ear 
is touched or manipulated in any way. While 
severe pain is the rule in ear disease, it may 
be absent; there may be loss of appetite, high 
fever, and restlessness for three or four days 
with no other sign of illness, and no evidence 
whatever of pain, when suddenly one discovers 
a yellowish discharge from the ear, with tem- 
porary or permanent relief from the symptoms. 

Management. — In case of an attack of ear- 



n8 Earache 

ache, dry heat is of much service. Rest the 
ear on a hot-water bag, or apply a salt bag, 
made by sewing together two pieces of muslin' 
about three by five inches in size and filling 
it half full with salt. The bag and contents 
are then pressed flat, heated, and applied to 
the ear, the salt retaining the heat for a long 
time. Another device is to fill the finger of 
an old glove with salt, heat it, and place the 
tip in the ear. As an extra precaution the 
mother or nurse should first test it in her own 
ear. A douche at no F. may also be of con- 
siderable service in these cases; in my experi- 
ence, earache is best relieved by this means. 
The child should be pinned in a sheet, and lie 
on its back, with its head on a level with or a 
little lower than the body. A basin protected 
with a towel or absorbent cotton is placed 
under the ear. One assistant is required to 
steady the head, as the child will be sure to 
struggle. The douche bag — an ordinary foun- 
tain syringe — should be held not more than 
two feet above the child's head. From one 
to two pints of sterile water may be needed. 
The tip of the syringe is placed about one- 
quarter of an inch from the orifice of the canal 
and the water is allowed to flow into the ear 



The Care of the Eyes 1 19 

until the child is relieved or until the bag is 
empty. In giving the douche, elevate the ear 
by grasping the tip with the fingers, thereby 
widening the opening. Such a douche may be 
repeated every hour until medical aid arrives. 
Earache is usually due to the presence of 
pus or other fluid behind the drum membrane. 
This causes pressure within the ear which may 
require a slight operation for its relief. 

THE CARE OF THE EYES 

The eyes should always be well protected 
from the sunlight, the young infant never be- 
ing allowed to lie with a bright light from 
a window streaming into its face. 

The eyes should be washed once daily with 
plain boiled water. A piece of soft old linen 
should be used and immediately burned. Be- 
fore touching the eyes for any purpose, the 
hands must be washed with hot water and 
soap. 

No other home treatment of the eye is al- 
lowable, however slight the ailment. The 
custom of putting breast-milk into the eyes 
cannot be too strongly condemned. Teas 
of various kinds and proprietary or home- 



120 Dentition 

made eye-washes should never be used. Over 
90 per cent, of the cases of blindness develop 
during early life, due to an infection which is 
neglected or badly treated. 

DENTITION 

Much has been written about the process 
of teething. Nearly all the ills of childhood, 
other than the contagious diseases, have been 
attributed to this cause. Not only the laity, 
but physicians, are often inclined to attribute 
this or that ailment to teething. Many a diag- 
nostic puzzle has been smothered under the 
diagnosis of dentition. Observations covering 
the teething period of several thousand children 
in institution, out-patient, and private work, 
among all classes and conditions of children, 
have taught me to divide teething babies into 
three groups : the breast-fed, the well-man- 
aged bottle-fed, the badly fed. 

The breast-fed. — In the great majority of 
the breast-fed, the teeth appeared at the 
proper time, with little or no disturbance. 
Perhaps there was a period of irritability and 
restlessness for a few days before the teeth 
came through. In many, the teeth appeared 



Dentition 121 

without the slightest inconvenience, and that 
a tooth had been cut was discovered while 
washing or dressing the baby. In a very few 
breast-fed babies there was distinct irritability 
and restlessness, with fever and a slight 
diarrhoea, all of which subsided when the 
teeth appeared. 

The well-managed bottle-fed, such as were 
given cows' milk, properly prepared and di- 
luted, teethed, as a rule, without inconvenience. 
Some showed a tendency to slight gastrointes- 
tinal disturbance, which was relieved by diet 
and simple medication. The cases which occa- 
sionally developed severe intestinal disturbances 
were those which cut the first molars or several 
other teeth at one time during the hot weather. 
Such infants must be kept on a very light diet 
until the teeth are through, or until the onset 
of colder weather. 

The badly fed. — These were nearly all 
bottle-fed. They were given cows' milk im- 
properly prepared or at too frequent intervals. 
Only condensed milk and the proprietary foods 
had been given some of these infants. To this 
class belong the great number of infants who 
are given bread, meat, potatoes, and sweets 
before the digestive organs are ready for such 



122 Dentition 

food. It is these badly fed, debilitated, 
rachitic infants who are said to "teeth hard." 
They teeth late, cut several teeth at one time, 
and have attacks of convulsions, diarrhoea, and 
vomiting during the teething period. There is 
no doubt that the alimentary tract is pre- 
disposed to troubles of a catarrhal nature dur- 
ing active dentition. If the baby has been 
properly fed and is in fair health, this tendency 
is so slight that it probably will not be noticed. 
If, on the other hand, the digestive tract is 
weakened from abuse, vomiting and diarrhoea 
often result. 

The influence of rachitis. — The majority of 
children who belong to the third group are 
rachitic, and rickets always mean enfeebled 
resisting powers. Rachitic children teeth late. 
A rachitic boy under my observation cut his 
first tooth during the ninth month, and with 
the eruption of this tooth and with each of the 
five that appeared at intervals of two or three 
weeks during the next five months, an attack 
of vomiting and diarrhoea occurred, each at- 
tack subsiding when the tooth pierced the 
gum. 

Complications. — Irritability and restlessness, 
slight fever and gastro-intestinal derange- 



Dentition 123 

ments, were the only unpleasant effects of 
dentition in any of my patients who were in 
fair health. The irritability, restlessness, and 
fever appeared to be due directly to dentition. 
Indirectly, teething may be a factor in gastro- 
intestinal derangements. The process may be 
painful, the digestive organs fail to act 
properly, and trouble follows. I have never 
known dentition to cause bronchitis, eczema, 
or skin eruptions of any kind. 

Possible dangers. — The opinion is very 
general among the ignorant, that bronchitis 
needs no treatment, and that diarrhoea is bene- 
ficial during the teething process. These be- 
liefs, equally dangerous, have been the cause 
of an incalculable amount of harm: as the re- 
sult, many lives are lost yearly. I have time 
and again seen children die with summer 
diarrhoea who were brought for treatment 
when no hope could be given. The mother 
had been told and believed that diarrhoea was 
beneficial to the teething child, and that if the 
diarrhoea were stopped the child would be 
thrown into convulsions. 

Management. — When the form of a tooth 
can be made out pressing on the gum, and the 
child is fretful and feverish, the digestive 



i24 The Teeth 

capacity is lessened, as previously mentioned. 
When such is the case the nourishment should 
be temporarily reduced one-half by the addi- 
tion of boiled water. If the child is breast- 
fed, the nursing period should be reduced to 
five or six minutes, and boiled water given to 
drink between feedings. If a tooth is trying 
to force its way through a thick, resistant gum, 
a great deal of pain and discomfort will be 
spared the child if the tooth is assisted in its 
progress. This is best accomplished by the 
use of a clean towel, which is placed over the 
finger and vigorous friction brought to bear 
over the sharp edge of the tooth. It is quicker 
and less painful than lancing, and the gum 
will not close over the tooth. 

THE TEETH 

Twenty teeth comprise the first set. In the 
well child the first tooth usually appears be- 
tween the sixth and the eighth months; the 
first teeth may, however, in perfectly normal 
cases, come earlier or much later. I have 
known well, vigorous children who did not get 
a tooth until the thirteenth month. The first 
teeth are usually the two lower central incisors ; 



The Teeth 125 

generally the four upper incisors and the two 
lower lateral incisors appear between the eighth 
and the tenth months. The first four molars 
appear between the twelfth and the fifteenth 
months; the eye- and stomach-teeth between 
the eighteenth and the twenty-fourth months; 
the four posterior molars between the twenty- 
fourth and the thirtieth months. This regu- 
larity in the appearance of the teeth is by no 
means constant even in well children. I have 
in several instances seen the upper lateral in- 
cisors appear first. In delayed dentition the 
teeth are very apt to appear irregularly. 

The care of the teeth. — As soon as the teeth 
appear they require attention. Until the 
second year is reached the mouth should be 
washed out at least twice a day with a solu- 
tion of boracic acid — one ounce to a pint of 
water. This can best be done by means of 
absorbent cotton wound around the tips of 
a clean index finger and afterward dipped into 
the solution, when it should be applied with 
gentle friction to the gums and teeth. When 
a child is two years old it is well to begin the 
use of a soft tooth-brush, and a simple tooth 
powder composed of the following ingredi- 
ents : 



i26 The Teeth 

Precipitated chalk, i ounce. 
Bicarbonate of soda, I drachm. 
Oil of wintergreen, a few drops. 

The child should also be instructed early 
as to the proper use of a quill tooth-pick. 

The milk-teeth are lost between the sixth 
and eighth years. They should not decay but 
fall out or be forced out by the second set. 
The teeth of every child over two years of age 
should be examined by a dentist every six 
months. If cavities are discovered in the first 
teeth they should be filled with a soft filling. 

The permanent teeth. — The permanent set 
comprises thirty-two teeth. The second denti- 
tion begins about the sixth year, and is usually 
completed about the twentieth year, although it 
may be delayed several years later. The per- 
manent teeth appear in somewhat the follow- 
ing order : 

First molars sixth year. 

Central incisors sixth to seventh year. 

Lateral incisors seventh to eighth year. 

First bicuspids ninth to tenth year. 

Second bicuspids .... ninth to tenth year. 

Canines eleventh to twelfth year. 

Second molars thirteenth to fifteenth year. 

Third molars after the eighteenth year. 



The Hair 127 

THE HAIR 

Whether the child should wear the hair long 
or short is a point upon which the doctor is 
likely to give unsought advice. There are two 
reasons why a child's hair should be kept short : 

1. From the standpoint of comfort. Dur- 
ing the hot months children perspire very 
freely both by day and by night. The heavy 
mass of hair which falls about the neck and 
shoulders adds greatly to the warmth and dis- 
comfort. I find that many children with long 
hair are poor sleepers and are irritable and 
hard to please when awake. In winter the 
child is very apt to perspire about the head 
and neck in active play, and runs a greater 
risk from exposure than if the excessive per- 
spiration did not occur. 

2. The hair should be kept reasonably short, 
because then the scalp can be kept in a much 
healthier condition, and a much better growth 
of hair assured in later life. 

NURSERY-MAIDS 

The mother who can afford the expense of 
a helper should never take entire charge of 



128 Nursery-Maids 

her baby; nor should she share this duty with 
the maid of all work if better assistance can 
be secured. The child requires more atten- 
tion than any one person should bestow. If 
one person is constantly in charge of the child 
it will either be neglected or the health of that 
person will suffer, and her services will be less 
efficient. Many a young mother has sacri- 
ficed her health because of a false sense 
of duty in this respect. The close con- 
finement in itself would ruin her health and 
make her prematurely old. The children that 
are born later have less vigor, are more sus- 
ceptible to illness, and start out handicapped 
in life as a consequence. The constant atten- 
tion of the mother is not necessary; in fact, it 
is often injurious to the child. She is apt to 
handle the child too much, to over-entertain it. 
A bright young woman should be secured as 
soon as the monthly nurse leaves, to assist in 
the care of the child. If she is a trained 
nursery-maid who has had previous experience 
of the right kind, she will be invaluable. In 
case a trained assistant is not to be obtained, 
any intelligent young woman of cleanly habits, 
and who is fond of children, may be trained 
at home in a few weeks. 



The Trained Nurse 129 

THE TRAINED NURSE 

If possible, a trained nurse should be em- 
ployed in every severe illness of childhood. 
She may alternate with the mother or nursery- 
maid in the care of the child. If the case is 
very urgent, two trained nurses should be 
employed. The nurse must never be expected 
to work for more than twelve consecutive 
hours. A tired nurse should never be in charge 
of a sick baby. 

The employment of a trained nurse does 
not mean that the mother may not perform 
many little offices for the patient, but the 
trained nurse should be in charge, and her 
opinions respected. 

Many an excellent mother makes a very poor 
nurse for her own child during a severe illness. 
Her great interest and anxiety impair her 
judgment. She is apt to become con- 
fused and fail to meet emergencies. A 
mother who is useless for a like office 
in her own household oftentimes makes 
an excellent nurse for her friend's child. 
The mother in the capacity of a nurse 
for her own infant is apt to fail under some of 



13° The Trained Nurse 

the following conditions : She is inclined to 
put more clothing on the baby than the doctor 
advised. If a window is the means of ventila- 
tion, she has a strong inclination to close it a 
little beyond the point which the physician 
marked with a lead-pencil. The temperature 
of the sickroom is often kept higher than is 
good for the baby. Offices, the performance 
of which cause the child discomfort, are often 
not thoroughly attended to, such as washing 
the eyes, sponging off the patient in fever, 
syringing the ears, and adhering to a greatly 
restricted diet. These, and a few like offenses, 
are pardonable in the mother, but they show 
us that in a severe illness trained help is indis- 
pensable. Further, I am very sorry to say that 
sometimes influences against carrying out the 
physician's directions in important particulars 
are successfully brought to bear upon the 
mother by well-meaning relatives and friends 
who possess no knowledge whatever of the ill- 
ness in question. 

ADENOIDS 

Adenoids are tumor-like growths that de- 
velop at the junction of the upper portion of 



Adenoids 13 J 

the posterior pharyngeal wall and the vault of 
the pharynx. They may simply cover the sur- 
face of the parts in a spongy layer or they may 
fill the entire naso-pharyngeal space, com- 
pletely blocking the passage from the nose to 
the throat. They are not to be considered as 
new growths, but rather as hypertrophies, or 
overgrowths, of the mucous glands and tissues 
of the parts. They may vary in size from a 
flaxseed to a walnut. Among the causes of 
adenoids may be mentioned the use of the 
"pacifier" in infancy, repeated "colds" in the 
head, breathing the dust-laden air of our large 
cities, malnutrition, and unhygienic living. 
While the taking of cold is a factor in the de- 
velopment of adenoids, my observation is that 
predisposition plays an important part. Many 
children have a tendency to glandular enlarge- 
ment ; in fact, in this country, a large percent- 
age of the children under ten years of age have 
adenoids. In a child under two years of age 
the naso-pharyngeal space is a very narrow 
slit; and since the majority of children up to 
the eighteenth month of life are sucking on 
something the greater part of their waking 
hours, the soft palate is forced back against 
the posterior pharyngeal wall, interfering with 



13 2 Adenoids 

the drainage of the parts, and on account of 
the friction of the opposed surfaces congestion 
and irritation follow, resulting finally in a 
general hypertrophy. 

Age. — Very young children may have 
adenoids. The youngest patient that I have 
operated upon was eight months old. The 
majority of cases occur in children from 
eighteen months to six years of age. A slight 
amount of adenoid growth may cause no symp- 
toms. A few summers ago I examined the 
throats of forty children between the ages of 
two and five years, who came for treatment 
for other conditions. In thirty-seven, ade- 
noids were present. In twelve, operation was 
advised, and in five, operation was performed. 
In fifteen the growths were not sufficiently 
large to justify operation in the absence of 
annoying or dangerous symptoms. 

The presence of adenoids is perhaps most 
often manifested by symptoms of chronic cold 
in the head. There is a great deal of discharge 
from the nose. The child has snuffies all win- 
ter. During summer there is little if any 
trouble. The child is said to take cold easily. 
The slightest exposure will cause a running at 
the nose. Cough is often associated with the 



Adenoids *33 

nasal discharge, or it may follow it. The 
cough is worse at night; in fact, it often is not 
noticed until the child goes to bed. Such a 
cough was formerly known as "the nervous 
cough" or "the stomach cough." 

Mouth-breathing. — If the growths are large, 
we have mouth-breathing added to the other 
symptoms. The child breathes through the 
mouth both day and night for the reason that 
the breathing space through the nose is choked. 
The night mouth-breathing gives rise to snor- 
ing; some of these children snore like adults. 
Almost every snoring child will be found to 
have either adenoids or enlarged tonsils, or 
both. 

In advanced cases the appearance of the face 
of the patient is characteristic. The habitual 
open mouth gives the face a stupid expression. 
In fact, such children are apt to be mentally 
dull. The nostrils are small and pinched. The 
upper lip is usually thickened. The voice is 
also affected; there is a decided nasal twang, 
and articulation is sometimes impaired. The 
child has trouble in blowing his nose. Occa- 
sionally adenoids are the cause of very severe 
nosebleed. In a small proportion of the cases 
hearing is impaired. Bed-wetting may be due 



134 Enlarged Tonsils 

to adenoids. Recently a writer reported seven 
cases of inveterate bed-wetters, all cured by 
the removal of the adenoids. Children with 
adenoids are more susceptible to diphtheria, 
and if they contract the disease it is apt to be 
more severe. For adenoids of any degree of 
severity, complete removal is the only treat- 
ment. Sprays and the various local applica- 
tions are absolutely worthless. The operation 
is practically without danger. 

ENLARGED TONSILS 

Chronic enlargement of the tonsils is almost 
always associated with adenoids and is re- 
sponsible in a degree for their presence. We 
see many cases of adenoids, however, in which 
there is no tonsillar enlargement. Predisposi- 
tion and repeated attacks of acute tonsillitis 
lead to chronic enlargement of the tonsils. 
Enlarged tonsils, when associated with ade- 
noids, do not change the character of the symp- 
toms of adenoids except to aggravate them; 
therefore they should be removed as well as 
the adenoids. All other treatment in young 
children is useless. The operation in skilful 
hands may be said to be practically without 
danger. Parents always dread the operation, 



Milk in Infants Breasts 135 

but the relief afforded the suffering child, and 
the knowledge that a serious obstacle to the 
child's growth and development has been re- 
moved, will repay them for their hours of 
anxiety. Gargles and sprays are of little or 
no value in chronic enlargement of the tonsils. 

MILK IN INFANTS' BREASTS 

It is not at all uncommon for an infant's 
breasts, at birth, to contain a substance resem- 
bling milk. When this occurs, the breasts are 
to be left alone and the milk will disappear. It 
is quite a common belief among hospital and 
dispensary patients that the milk should be 
pressed out. This is very wrong. In two 
cases I have known abscesses to develop after 
this treatment by a midwife, and in one case 
the child nearly lost its life. 

TEMPERATURE, AND HOW TO 
TAKE IT 

The normal rectal temperature of an infant 
varies between 98. 5 ° and 99. 5 F. The tem- 
perature should be taken in the rectum. The 
mouth is impossible, the groin and axilla ab- 
solutely unreliable. The child should lie on 



136 Appetite 

its stomach either in its bed or across the 
nurse's lap. Both the anus and the bulb of 
the thermometer should be well oiled. The 
bulb is passed into the rectum so that the mer- 
cury cannot be seen and allowed to remain two 
minutes. If the child kicks or struggles some 
one should hold its legs. Mothers are often 
disturbed because of a persistence of the tem- 
perature between 99. 5 and 100.5 F. While 
such a degree cannot be considered normal, it 
does not follow that it is of any consequence. 
This slight elevation may follow the acute ill- 
nesses such as grippe, pneumonia, and scarlet 
fever, and may continue for weeks, without 
any harm resulting. Nervous, irritable infants 
will often range at ioo° F. for weeks at a time. 
In like manner children who are stimulated by 
playing with older children or with adults will 
often develop a rise in temperature which sub- 
sides as soon as the cause is removed. 

The thermometer should be washed with a 
one-per-cent. solution of carbolic acid or alco- 
hol after using. 

APPETITE 

It may be safely said that a well, vigorous 
child is a hungry child, and nearly every child 



Appetite 137 

may be made thoroughly hungry three times 
a day by suitable food at proper intervals. The 
children who come under my care for poor 
appetite, without evidence of disease to account 
for it, are, almost without exception, improp- 
erly fed. They are often given unsuitable 
food at meal-time, when they are loaded down 
with sweets and pastries; but the chief error 
is eating between meals. This habit has ruined 
more appetites and has been the cause of more 
stomach disorders than any other one factor. 
It is surprising what a large amount of candy, 
sweet crackers, and the like are disposed of 
in many households. Every year I am called 
upon to treat cases of loss of appetite in "run- 
abouts" from eighteen months to three years 
of age, who have what I have designated the 
milk habit. These children drink from five 
to six pints of milk a day, and refuse all other 
food. The milk satisfies the appetite but does 
not furnish the nourishment required for the 
rapid growth that takes place at this time, and 
the child in consequence suffers from malnu- 
trition. He is pale, thin, and sallow in appear- 
ance, the sleep is poor, and the child is irritable 
and hard to please. We also see children at 
this age who suffer from improper nutrition 



138 Appetite 

on account of too restricted a diet. They take 
other food than milk, but not in sufficient quan- 
tity or variety. Some will refuse all kinds of 
vegetables, others will refuse all kinds but one 
or two ; some will not take stewed fruit ; others 
will not touch meat or eggs, no matter how 
they may be prepared; some will take but one 
cereal, others will refuse cereals altogether. 
The child's whims in these respects must never 
be catered to. He is to take what is placed 
before him or go without until the next meal. 
Likes and dislikes for various articles of diet 
are largely a matter of education, and the 
child may, and should, be taught to eat every- 
thing that is good for him. A little firmness 
in compelling him to go hungry for a few 
hours will soon do away with any childish 
fancy, which may be the cause of considerable 
harm. These children are rapidly growing, 
and for proper growth and development re- 
quire a mixed diet. If the child is wedded to 
milk and refuses everything else, the milk must 
temporarily be discontinued. Some children 
with a poor appetite for solids will drink a 
glass or two of milk at the commencement of 
a meal. This satisfies the appetite for the time 
and nothing more will be taken. With such 



Appetite 139 

children the milk must be kept out of sight 
until the meal is completed, when one-half pint 
may be given. 

I have treated quite a number of cases of 
poor appetite and milk appetite in children 
otherwise well, in the following manner: The 
child is undressed and placed in bed and put 
under the care of one person as though he were 
very ill. The object in placing the patient in 
bed is to prevent his getting food other than 
that ordered. He is allowed water to drink in 
plenty. For the first day he is given four 
ounces of plain chicken or mutton broth every 
three hours. The second day he receives six 
to eight ounces of the broth at three-hour in- 
tervals. On the third day he is usually raven- 
ously hungry and he is then given three or four 
good meals, when, if he has any special dislike 
for any article of diet, that is included in the 
first meal. In such cases it is surprising with 
what favor the formerly despised cereal, meat, 
Qgg } Or vegetable will be looked upon, and it 
will thereafter have a cherished place in the 
child's heart. Some mothers will not be a 
party to such heartless treatment, as they are 
inclined to call it, but this is a wrong view to 
take of it. A complete change of diet for a 



140 Appetite 

day or two would often be of benefit to all of 
us. With the child the advantage derived 
from thus learning to enjoy a mixed diet 
will favorably influence his health for the 
rest of his life. Change of climate, fresh 
air, out-of-door exercise, suitable food at 
regular intervals — all favorably affect the 
appetite. 

Another effective means of combating the 
habitually poor appetite at any age after the 
eighteenth month, is, three meals a day at con- 
siderable intervals. The first meal at 7 130, the 
second at 12.30, the third at 5 130. Absolutely 
nothing but water is to be given between 
meals. A vast number of poor feeders have 
been changed to normally hungry children by 
this means. 

Children who over-exert themselves at 
school or at play or who are easily excited and 
have plenty of opportunity for excitement 
often suffer from loss of appetite. The man- 
agement of these cases is to remove the source 
of the trouble, whatever it may be. An ex- 
cellent means of bringing these children to a 
normal condition is an enforced rest for 
one and one-half hours after the noon-day 
meal. 



Habits H 1 

HABITS 

THE PACIFIER; EAR-PULLING; MASTUR- 
BATION 

Babies acquire habits most easily and at a 
very early age. Whether the habits are good 
or bad depends more upon the child's attend- 
ants than upon the child itself. If properly 
trained — and the training must begin at birth 
— a baby will acquire the habit of taking his 
food at regular intervals by day and by night, 
and he will also acquire the habit of going to 
sleep and waking at regular intervals. As a 
result of a careful regime regarding feeding, 
sleep, bathing, and airing, and the performance 
of its various functions at stated times every 
day the baby will soon develop into a "little 
machine," as one mother called her babe. Such 
a child causes no trouble and thrives far better 
than one who is fed every time he cries, day 
or night. A baby that requires constant enter- 
taining when awake, and that sleeps only when 
exhausted, usually has another bad habit, — that 
of being held constantly in arms. A baby 
should be handled very little, — just enough to 
give it evercise. It will learn to amuse itself 
at a very early age if given an opportunity. 



14 2 Habits 

The "pacifier" habit — the habit of sucking 
a rubber nipple — is an inexcusable piece of 
folly for which the mother or nurse is directly 
responsible. The habit when formed is most 
difficult to give up. The use of the "pacifier," 
thumb-sucking, finger-sucking, etc., make 
thick, boggy lips, on account of the exercise to 
which the parts are subjected. They cause an 
outward bulging of the teeth and a narrowing 
of the jaws, which are not conducive to per- 
sonal attractiveness. Nature has not been so 
lavish of her gifts to the great majority of 
mankind that they can afford to trifle with her 
handiwork. Furthermore, the "pacifier" is 
often a menace to health. If there are two 
or three young children in the family it is fre- 
quently passed around without other means of 
cleansing than being drawn a couple of times 
across the nurse's sleeve. This novel method 
of disinfecting the "pacifier" may be seen in 
actual use in the Park any pleasant day, and I 
have often seen the mother or nurse moisten 
the "pacifier" with her own lips before giving 
it to the child. I have seen young children 
fight for the "pacifier," one taking it from 
the mouth of another ! It may readily be con- 
ceived what a boundless source of harm this 



Habits 



i43 



little instrument may be, when every sort of 
disease known to childhood may be trans- 
ferred by it. Thus it may act as a means of 
transmitting tuberculosis, syphilis, diphtheria, 
and many other ail- 
ments of minor 
importance. In 
those with a ten- 
dency to vomit 
readily, the sucking 
habit will aid ma- 
terially in continu- 
ing the disorder. 

Adenoids, re- 
ferred to in another 
chapter, are often 
the result of thumb- 
sucking or the use 
of the "pacifier." The pressure exerted in 
sucking forces the soft palate against the pos- 
terior pharyngeal wall; this irritates and stim- 
ulates the glands of the part, which in time 
enlarge, and adenoids develop. 

Children, at any age, suffering from aggra- 
vated malnutrition will never thrive while they 
practice the thumb, finger or hand sucking 
habit. 




FIG. 7. THE HAND-I-HOLD MIT 



i44 Habits 

To break the child of the "pacifier" habit, 
burn the "pacifier" and do not buy another, 
as is sometimes done. For thumb-sucking and 
finger-sucking, bandage the hands and moisten 
the bandage occasionally with a solution of 
quinine. 

The "Hand-I-Hold Mit" (Fig. 7) is a use- 
ful means in breaking the habit. The size 
varies according to the age of the child. The 
"Hand-I-Hold Mit" may be obtained at 
Spangenberg, 82nd Street and Columbus 
Avenue, New York City. 

A few children develop the ear-pulling 
habit. It is always one ear which receives at- 
tention. Sometimes it is the lobe and some- 
times the upper portion. The child pulls on 
the ear the greater portion of its waking hours. 
As a result of this practice, I have seen ears 
drawn entirely out of shape. Bandaging the 
hands so that the fingers can not be used to 
grasp the ear is the best means of breaking the 
habit. The "Hand-I-Hold Mit" may also be 
used with advantage. 

Occasionally children are met with who 
have a mania for placing foreign bodies in the 
nose and ear. Shoe buttons are the favorites, 
although beans, pieces of coal, pebbles, and 



Habits 145 

various other kinds of buttons serve the pur- 
pose when shoe buttons are scarce. The habit 
is best controlled by a vigorous spanking fol- 
lowing each offence. 

Masturbation is one of the most injurious 
of habits. It consist in an irritation of the 
genitals by manipulation, by leg-rubbing, or 
by pressing the parts against some pointed 
object. Under the age of six years mastur- 
bation is more common in girls than in boys. 
My youngest patient was a girl only six months 
old. If the habit is not detected, masturbation 
may be practiced for a long time and repeated 
many times a day. As a result, the child be- 
comes irritable, loses sleep and weight, and is 
transformed into a condition of mental and 
physical exhaustion. 

The formation of habits and their cor- 
rection rests largely with the mother or at- 
tendant. Considerable stability is necessary 
for the correction of a bad habit, or the forma- 
tion of a good one. It means several prolonged 
crying attacks on the part of the child and per- 
haps two or three wakeful nights. 

Management. — To cure the habit of mastur- 
bation, if the child is under eighteen months 
of age, the hands may be bandaged, or, what 



14 6 The Normal Throat 

is better, a piece of tape may be fastened around 
each wrist and tied together at the back of the 
neck, making all secure with a safety-pin. The 
pieces of tape should be of sufficient length to 
allow the child free movement of the hands, 
but not long enough to allow them to come in 
contact with the genitals. 

Leg-rubbing is more frequently seen in very 
young girl babies. In such cases the wearing 
of a thick napkin or of two napkins will usu- 
ally prevent the practice. In some obstinate 
cases of leg-rubbing in older girls I have used 
a "knee crutch" with decided success. In 
children over two years of age, constant watch- 
fulness and vigorous punishment for each of- 
fense, combined with medical treatment, will 
cure most cases, although with some much 
difficulty will be experienced. 

The practice must be prevented and the 
genitals brought to a normal condition, when 
the patient will soon forget the indulgence. 

THE NORMAL THROAT 

Every mother should learn the appearance 

of the healthy throat, and every child should 
be accustomed to throat examination. It will 



How to Examine the Throat 147 

soon learn that no harm is intended and force 
will not be required. The family physician 
should demonstrate to the mother the color 
of the normal mucous membrane, and the size 
and appearance of the tonsils in health. By 
knowing the normal throat she will be able to 
recognize inflammation, swelling, and exuda- 
tion in the form of the cheesy dots seen in ton- 
sillitis, and the membrane in diphtheria. With 
the first appearance of exudation of any kind, 
medical aid should be summoned. No chances 
should be taken with these cases. I know of 
fathers and mothers who will never cease to 
regret that they did not appreciate the dangers 
of temporizing with what they considered 
a "cankerous sore throat." Diphtheria is 
most insidious in its onset and a sore throat 
should never be neglected. 

HOW TO EXAMINE THE THROAT 
(See Fig. 8.) 

In order to examine a baby's throat quickly 
and thoroughly the child must be held in front 
of and at the right side of the attendant, sup- 
ported by the attendant's left arm under the 
buttocks; the right arm, which is thus left 



i4 8 How to Examine the Throat 



free, is passed around the child, binding its 
arms to its sides. The child's head rests upon 
the right shoulder of the attendant. 

The mother places her left hand on the 
child's head to steady it and with tongue de- 
pressor or teaspoon in her right hand she 




FIG. 8. THE THROAT EXAMINATION 

presses down the tongue, and, with the child 
under perfect control, she brings into view 
the parts that are to be examined. The most 
satisfactory view can be obtained by daylight 
before a window. If the examination is made 
in the evening, a lamp or taper held by a third 



Sprue and Thrush H9 

party, a trifle above and behind the mother's 
right shoulder, will furnish a satisfactory 
illumination. 

SPRUE AND THRUSH 

Thrush consists of a parasitic growth which 
appears on the mucous membrane of the mouth 
in young infants. The disease makes its ap- 
pearance in the form of small white masses 
about the size of a pinhead. The tongue and 
the inner side of the cheeks are favorite sites 
for the growth, although in severe cases the 
entire buccal cavity may be studded with it, 
causing it to look as though finely curdled milk 
had been scattered over the surface. The 
growth is firmly adherent, and if removed 
forcibly, slight bleeding results. It is usually 
associated with uncleanliness, and occurs, as 
a rule, in weakly and marasmic nurslings and 
in the bottle-fed, more frequently in the latter. 
It is rarely seen after the sixth month. 

In an infant with sprue, there is evidence 
of much pain and discomfort while nursing or 
while feeding from a bottle. The disease is 
not contagious. The average case may easily 
be cured in a week, if the directions for the 
treatment are carefully carried out. Active 



15° Sprue and Thrush 

gastro-enteric disturbances, such as vomiting 
and diarrhoea, may be associated with sprue, 
but it is not the rule. Time and again I have 
seen cases of sprue in which there were abso- 
lutely no other signs of the disease aside from 
the characteristic mouth lesions and the refusal 
of food. 

If the means of prophylaxis, which will be 
suggested, are used as the daily routine, the 
disease will never appear. 

Sprue in the breast-fed. — If breast-fed, the 
mother's nipples must be washed with a satu- 
rated solution of boric acid, and moistened 
with alcohol, diluted one-half, which is al- 
lowed to evaporate before each nursing. If 
bottle-fed, the nipple and bottle should be boiled 
after each nursing, the nipple turned inside 
out and scrubbed with borax water — one ounce 
of borax to a pint of water. 

The mouth toilet. — Whether breast-fed or 
bottle-fed, the mouth should be washed with 
a saturated solution of boric acid after each 
nursing. For this purpose a generous amount 
of absorbent cotton is loosely wrapped around 
the clean index-finger of the mother or nurse. 
This is placed in the cold solution, and with- 
out pressing out the water the finger is intro- 



Stomatitis, or Sore Mouth 15 1 

duced into the child's mouth, and, in cases of 
sprue, brought gently in contact with the dis- 
eased parts, first with one side and then with 
the other, being pressed upon the tongue and 
under the tongue. It is well to have the child 
rest on its side or stomach so that the fluid 
which is pressed out by the manipulation of the 
cotton against the cheeks and jaws can readily 
escape from the mouth. The washing, which 
really amounts to an irrigation, can be done 
in a few seconds, without the slightest danger 
of abrading the epithelium. 

Internal medication is no value in sprue ex- 
cept in correcting any intestinal derangement 
that may exist, with a view to improving the 
general condition. If the bottle or breast is 
refused, spoon-feeding for a few days may 
be necessary, and will hasten a cure. If the 
child is nursed, the mother's milk may be 
drawn with a breast-pump (see page 49), or 
pressed out with the fingers, and fed to the 
child. The domestic remedy, honey and borax, 
should not be used in any of the inflammatory 
diseases of the mouth in children. 

STOMATITIS, OR SORE MOUTH 
There are three varieties of this disorder — 



15 2 Stomatitis, or Sore Mouth 

the catarrhal, the aphthous, and the ulcerative. 

In the catarrhal form there is redness of 
the gums with excessive secretion of saliva. 

In aphthous stomatitis, distinct grayish- 
white plaques will be noticed on the inner 
side of the cheek and under surface of the 
tongue, varying in size from a pinhead to a 
split pea. 

Ulcerative stomatitis is the most serious 
disease of the three. It may occur during 
serious illness, but in most instances it occurs 
independently. There is a general conges- 
tion of the mucous membrane with the secre- 
tion of a great deal of saliva. Its distinguish- 
ing point, however, is the line of ulceration 
which forms on the border of the gum at its 
junction with the teeth. The ulceration may 
be so severe as to cause a loosening and fall- 
ing out of the teeth. The breath is often 
very foul, and the gums bleed at the slightest 
touch. 

Lack of cleanliness plays a large part in 
causing sore mouth. Unclean feeding appa- 
ratus, the use of the "pacifier," and the custom 
of allowing a baby to put into its mouth every- 
thing within reach account for a majority of 
the cases. 



Taking Cold 153 

The symptoms are fever, loss of appetite, 
and evidences of much discomfort when the 
child attempts to eat. In many cases of the 
ulcerative form there is high fever and greater 
prostration than one would think possible. 

The prevention and treatment are the same 
— cleanliness. The sore mouth should be 
washed with a saturated solution of boric acid 
after each feeding, using absorbent cotton, 
which is wrapped around the index finger. The 
cotton is saturated with the solution and gently 
brought into contact with the diseased surface. 
Force must not be used in these cases, as more 
damage than benefit will result if the tissues 
are lacerated. In the ulcerative form internal 
treatment is required in addition to the local 
means suggested. Every case of ulcerative 
stomatitis should be seen, at least once, by a 
physician. 

TAKING COLD 

By "taking cold" we understand that 
through the influence of cold upon some por- 
tion of the skin an impression similar in na- 
ture to that of shock is produced, which affects 
the entire body and manifests itself most fre- 



154 Taking Cold 

quently in the form of a congestion of the 
mucous membrane of the respiratory tract, 
between which and the skin there seems to be 
an intimate connection. Micro-organisms play 
an important role in the process. They are 
found in large numbers on the diseased mucous 
surfaces. The changes in the mucous mem- 
brane resulting from the exposure prepare the 
parts for their growth and development. The 
taking of cold usually means previous exposure, 
and what will constitute a sufficient degree of 
exposure in one individual may produce no 
effect in another. According to my observa- 
tion, the most frequent cause of colds in in- 
fancy is the action of cold air on a moist skin. 
The child that perspires readily, or the child 
that is made to perspire by unsuitable cloth- 
ing, suffers most in this respect during the 
cold season. I look upon inadequate head- 
covering as a most frequent cause of diseases 
of the respiratory tract in the young. Most 
infants are dressed for the daily outing in a 
warm room, with the temperature ranging 
from 75° to 85 . The child is wrapped in 
ample coats, blankets, and leggings; he is ac- 
tive, throws his legs and arms about ; the dress- 
ing thus far requires quite a period of time; 



Taking Cold 155 

he perspires freely, but the dressing is not com- 
pleted. On the head is placed one of the more 
or loss artistically decorated airy creations 
which are sold in the shops as children's caps. 
They furnish little protection for the many 
square inches of the almost bald little head. 
The child is taken out of doors ; a wind is blow- 
ing ; the result is a cold ; and how it came about 
is never understood. He was supposed to be 
dressed ideally for cold weather. The idea is 
common and to a certain degree proper that a 
child's head should be kept cool. This theory, 
however, gives rise to carelessness as to the 
head-dress. During the colder months I ad- 
vise mothers to make a skull-cap of thin flannel, 
which the child can wear under the regular 
outing cap. 

Allowing a child to sit on the floor during 
the winter months is probably the next most 
frequent cause of taking cold. Kicking off 
the bedclothes at night is another frequent 
cause. Taking the child from a warm room 
through a cold hall is not without danger. 
Holding the child for a few moments by an 
open window during the cold weather is often 
followed by croup, bronchitis, and pneumonia. 
The uneven temperature of the living- and 



156 Taking Cold 

sleeping-rooms in many of our New York 
apartments is a very frequent cause of cold. 
Frequently during the day the temperature will 
be between 75 and 8o°, but at night, when the 
fires are banked, it falls to 55 or 6o° or lower. 
The child went to bed warm and perspiring, 
kicked off the bedclothes, the temperature in 
the room fell, the body became chilled, and the 
child took cold. 

Among rachitic children there is a marked 
predisposition to catarrhal affections; they 
acquire laryngitis and bronchitis upon very 
slight provocation. 

In many instances colds in infants are attrib- 
uted to the bath. Among dispensary mothers 
this is often considered a cause of cold. I 
have never known a cold to be due to a bath. 

Colds — contagious. — Adults and "runabout" 
children with coughs and colds should not 
come in contact with infants. There is un- 
doubtedly an element of contagion in such 
cases. It is a very bad practice to have a 
family pocket-handkerchief. The youngest 
infant is entitled to a handkerchief indepen- 
dent of the other children, and a handkerchief 
should never do service for more than one in- 
dividual between washings. 



Cough 157 

Prevention. — Mothers can do little without 
medical aid in the treatment of colds, but they 
can do much in preventing them. The tem- 
perature of the living-room should range from 
65 to 68° F., the sleeping-room from 50 to 
6o° F. Of course it will be impossible to 
keep the temperature at all times at these fig- 
ures, but the closer it approximates to them the 
safer the child will be. 

Children must not be allowed to sit on the 
floor during the winter. They can have their 
playthings on the bed, on the sofa, or in a 
clothes-basket, which may be raised on two 
thick pieces of wood or a couple of books. 
There is always a draught near the floor. The 
"pen," referred to on page 310, is the best 
scheme that I know of for keeping children 
from the floor. 

The room in which the child is dressed for 
an outing should not be above 70 F. Securely 
pinning bed-blankets to the mattress, or, better, 
a combination suit with "feet" will do much 
to prevent the child from taking cold at night. 

COUGH 

The most frequent cause of the temporary 
cough seen daily in children's work is almost 



158 Cough 

always an acute inflammatory condition of the 
mucous membrane of the respiratory tract, 
involving usually the fauces, the larynx, and 
bronchi, subjects which are referred to under 
their respective headings. 

Chronic cough. — Ninety-five per cent, of 
the obscure coughs are due to adenoid vege- 
tations in the naso-pharyngeal vault. Incipi- 
ent tuberculous infiltration in any portion of 
the lungs or pleura may produce the persistent 
cough. Thorough physical examinations and 
careful observation of the case for a few days 
will make a diagnosis possible. Whooping- 
cough without the whoop or vomiting may 
cause a persistent cough. It runs its course 
and subsides in from four to eight weeks. A 
diagnosis of such mild cases of whooping- 
cough is possible only when there is a history 
of exposure to the disease. I have had occa- 
sion to examine and treat many children who 
were brought to me because of a "cough" 
which had not been controlled by the measures 
employed. While we hear much of the cough 
of teething, the "stomach cough," the "nervous 
cough," and the "habit cough," it has never 
been my lot to see a case in which the cough 
was not connected in some way with the res- 



Cough 159 

piratory tract. Thorough examination of 
these cases, perhaps repeated examinations, 
will be required before the site of the trouble 
is definitely located, when it will almost in- 
variably be found somewhere in the respira- 
tory tract. The stomach cough, the nervous 
cough, and the teething cough formerly stood 
for the persistent cough which could not be 
accounted for by physical examination of the 
chest or by mere inspection of the throat. 
They are frequently referred to by the older 
writers. An elongated uvula, to which these 
obscure coughs have also been attributed, is 
very rarely a cause. The history is usually 
only that of a persistent cough. It may be 
irritating in character, keeping the child 
awake at night, or it may be paroxysmal, the 
attacks being more severe when the child is 
lying down. Many times the paroxysms are 
so severe, being particularly worse at night, 
that whooping-cough is suspected because of 
the absence of chest signs. 

Cough due to adenoids. — An immense 
majority of these obscure coughs in children 
are due to adenoid vegetations with or with- 
out enlarged tonsils. A child with such a 
cough may have the typical adenoid face, 



160 Cough 

mouth-breathing, and other signs referred to 
(see Adenoids, page 130), or these symptoms 
may be entirely absent. It is the latter type 
of case that is particularly puzzling and apt to 
be overlooked. On account of the absence of 
mouth-breathing and other symptoms of nasal 
obstruction, the possibility of adenoid vegeta- 
tions has been ignored. In these cases 
careful inquiry will usually elicit the 
history of frequent colds, or what is 
styled ''catarrh," as there is more or 
less serious discharge from the nose, or the 
child is said to "take cold in the head easily." 
Digital examination of the naso-pharyngeal 
vault will reveal a fringe of soft adenoid 
growth at the upper portion of the posterior 
pharyngeal wall, not large enough to produce 
obstruction, but actively secreting. This secre- 
tion, if not profuse, is partially evaporated in 
the nostrils, or if profuse, is discharged from 
the nostrils or passes backward over the pos- 
terior pharyngeal wall, thus provoking cough, 
when the child is up and about. When the 
child rests on his back, the secretion naturally 
flows over the posterior pharyngeal wall, and 
a cough is the result. Time and again I have 
relieved the most obstinate cough by curetting 



Cough 161 

and removing this sponge-like tissue. In one 
patient, a boy two years of age, who had been 
coughing hard for ten days with paroxysms 
and vomiting, a diagnosis of whooping-cough 
had been made by a member of the family who 
had seen many cases of whooping-cough, and 
also by myself. Adenoids were found to be 
present in a slight degree. Their removal 
was advised, with the idea of making the 
coughing attacks less severe, when, greatly to 
our surprise, the coughing ceased at once, 
not a paroxysm occurring after the growth 
was removed. The cough was due to the 
adenoid vegetations and not to whooping- 
cough. 

Cough caused by tracheitis. — Tracheitis (in- 
flammation of the windpipe) will produce a 
cough, severe and intractable, with no signs 
in the chest. In these cases, however, the 
cough is usually sudden in its development. It 
is often accompanied by slight fever, and if 
the child is old enough he will aid us by re- 
ferring to the sense of discomfort and tight- 
ness which exists over the upper portion of 
the chest. Sometimes the sensation will be 
described as a burning, which is located directly 
over the trachea. 



1 62 Tonsillitis 

TONSILLITIS 

Tonsillitis, or inflammation of the tonsils, 
is a very common ailment among children 
during the cooler months. It usually follows 
exposure. The onset is generally sudden, with 




FIG. 9. COLD COMPRESS 

high fever — 103 to 105 F., — pain, swelling, 
headache, and general muscular soreness. In- 
spection of the throat will show the tonsils to 
be swollen and inflamed. The entire throat 
generally has a congested appearance. No 
other changes may be noticed. In the majority 
of cases, however, the tonsils will be found 



Cold in the Head 163 

studded with small white dots of a cheesy ma- 
terial. If the case is seen two or three days 
after the beginning of the illness the dots may 
have coalesced, forming large yellowish patches 
which so closely resemble the appearance of 
the throat in diphtheria, that it may be im- 
possible for the physician without the aid of 
a microscope to differentiate between the two 
diseases. An attack of tonsillitis runs its 
course in from two to five days. 

Management. — Cold applications, cold com- 
presses (see cut) to the throat, and cold spong- 
ings of the body afford the patient much re- 
lief. A dose of castor-oil given at the first 
symptom of the disorder will always be of 
value. 

COLD IN THE HEAD (CORYZA) 

A cold in the head is a very frequent occur- 
rence in the young, and while not serious if 
the trouble limits itself to the mucous mem- 
brane of the nose, it is, nevertheless, a source 
of much annoyance to both mother and child. 
The mucous membrane of the nasal passages 
is congested and swollen. The nostrils of in- 
fants in health are very narrow, so that a slight 



164 Bronchitis 

congestion will greatly interfere with the 
breathing. 

The first sign to be noticed is that when 
the child is nursing he is unable to breathe 
easily through the nose, and frequent rests are 
necessary. Sleep, for this reason, is also inter- 
fered with. The baby sneezes more than usual 
and there is a watery discharge from the nose 
with usually a degree or two of fever. 

Management. — With the onset of the first 
symptoms, one teaspoonful of castor-oil will 
be of service. A few drops of melted vaseline 
or liquid albolene may be dropped into the nos- 
trils every two hours. 

The danger from a so-called "cold in the 
head" rests in the fact that the inflammation 
does not always limit itself to these parts. It 
is very liable to extend to other portions of the 
respiratory tract, terminating sometimes, even 
if properly treated, in bronchitis of broncho- 
pneumonia. 

BRONCHITIS 

Bronchitis may occur as a primary illness, 
or it may follow a cold in the head, laryn- 
gitis, or any inflammatory condition of the 



Bronchitis 165 

respiratory tract. It often occurs as a com- 
plication of other diseases. There is almost 
always more or less bronchitis with measles. 
In bronchitis we have a serious illness not 
necessarily serious in itself but mainly so be- 
cause of the frequency with which it leads 
to catarrhal pneumonia. Bronchitis in a deli- 
cate child requires but a little bad manage- 
ment or neglect and pneumonia will surely 
develop. 

The reason why bronchitis is a dangerous 
illness in a young child is because of the lack 
of development of the parts which form the 
chest walls. The ribs are soft and the mus- 
cles weak. The bronchial tubes collapse 
readily. In an older child the bronchial secre- 
tions are coughed into the mouth and swal- 
lowed or expectorated. The young infant 
cannot expectorate. When the secretion is 
viscid and thick, the weak chest-wall fails to 
furnish the power required to expel it and 
instead it is drawn deeper into the lungs, the 
smaller tubes become clogged with mucus, the 
air vesicles collapse, bacteria multiply rapidly 
in the confined secretions, and pneumonia re- 
sults. 

Bronchitis is indicated by coughing and 



166 Bronchitis 

wheezing, and what the mother often calls 
"a drawing of the chest." In many cases 
fever is present in a marked degree. The 
severity of the cough and the other symptoms 
depend entirely upon the severity of the lesions. 
In many cases, if seen early the disease will 
respond to treatment in a day or two. 

Management. — A generous counter-irrita- 
tion of the chest with one part of turpentine 
and three parts of camphorated oil is a useful 
measure, the applications to be made twice a 
day — morning and evening. What is better, 
however, is the use of the mustard plaster, 
made by mixing one part of mustard with 
three parts of flour, sufficient warm water 
being added to make a paste, which may be 
spread on cheese-cloth or thin muslin. It 
should be large enough to encircle the chest, 
fitting the child like a jersey. This is covered 
with another piece of similar material and the 
plaster is complete. It should be wrapped 
around the chest and allowed to remain from 
ten to fifteen minutes — until the skin is thor- 
oughly reddened. 

Proprietary cough mixtures and home reme- 
dies should never be relied upon for the treat- 
ment of bronchitis in children. 



Croup 167 

CROUP 

CATARRHAL CROUP; DIPHTHERITIC CROUP 

There are two varieties of croup, catarrhal 
and diphtheritic : catarrhal croup is a catarrhal 
inflammation of the larynx, and diphtheritic 
croup a membranous inflammation of the 
larynx. 

Catarrhal croup may begin in two ways. 
The child will suffer from snuffles, indicating 
a simple cold in the head, which is followed 
by a slight fever and a mild cough. The cough 
rapidly becomes worse and is hoarse and bark- 
ing in character, becoming more severe toward 
evening. As a rule, the fever is not high. In 
the evening of the second or third day of the 
illness, sometimes the first day, signs of ob- 
struction to the breathing become apparent. 
The inspiration is labored and accompanied 
by a croaking sound. The child cannot speak 
above a whisper. 

Probably not over half of the cases show 
this gradual development. In many the on- 
set is sudden : the child goes to bed as well as 
usual; after a quiet sleep of a few hours he 
awakes suddenly, sits up in bed, and with 



1 68 Croup 

high-pitched cough, straining for breath, he 

startles the household. 

Membranous or diphtheritic croup is much 
the more dangerous affection, but to the 
mother there is no means of distinguishing 
between the two forms, unless the child has 
diphtheria and the croup follows. The two 
forms may appear in identically the same way, 
although the onset of the diphtheritic croup 
is usually more gradual. 

Management. — In case of a severe cough or 
a sharp attack of croup in one of the children, 
the mother or nurse in charge has three duties 
to perform : send for a doctor, isolate the child, 
and give him a teaspoonful of the syrup of 
ipecac, which may be repeated in fifteen min- 
utes if there is no vomiting. Every case of 
croup should be quarantined until the nature 
of the trouble is determined If it is catarrhal, 
no harm will be done by the isolation. If it 
is diphtheritic, the lives of other members of 
the household may be saved by the precaution. 
If a croup-kettle is at hand (see cut 10), it 
should be brought into use after making a tent 
by covering or draping the crib with a sheet 
(see cut ii ). If an alcohol lamp is used for 
the kettle it is far safer to place the croup- 



Croup 



169 



kettle in a large dish pan. A common teapot 
can be used in an emergency. One teaspoon- 




FIG. 10. THE HOLT CROUP-KETTLE 



ful of tincture of benzoin or pine-needle oil 
is added to one quart of water and placed in 
the kettle, which is heated by the alcohol lamp 
attachment. A cold compress (page 162) ap- 
plied to the throat is often beneficial also. It 



170 



Croup 



should be thoroughly wrung out, covered with 
some dry material, and changed every twenty 




FIG. II. CRIB PREPARED FOR STEAM INHALATION 



minutes. The child should receive a laxative 
as early as possible in the attack. 



Pneumonia 171 

PNEUMONIA 

Pneumonia, sometimes referred to as in- 
flammation of the lungs, or lung fever, occurs 
very frequently in infants and young children. 
It may appear as an independent affection or 
as a complication of other diseases. There are 
two varieties which are commonly met with in 
the young: lobar pneumonia, which corre- 
sponds closely to the adult type, and broncho- 
pneumonia, or, as it is sometimes called, ca- 
tarrhal pneumonia. 

Lobar pneumonia usually results from ex- 
posure — a sudden chill of some part of the sur- 
face of the body. 

Broncho-pneumonia is usually the outcome 
of bronchitis or what is known as "common 
cold." 

The latter is most frequently seen in chil- 
dren and is usually the variety which occurs 
as a complication of other diseases. The mode 
of onset of the two types varies. 

Lobar pneumonia. — With lobar pneumonia 
the onset is sudden; there may be a chill or a 
convulsion. Sometimes vomiting ushers in 
an attack. The fever rises rapidly to 103 or 
105 F. The face is flushed and wears an 



17 2 Pneumonia 

anxious expression; the breathing is rapid, the 
respirations being from 40 to 60 a minute, 
the expiration being accompanied by a peculiar, 
partially suppressed sigh. The child is very 
restless, often delirious, or there may be stupor, 
with symptoms pointing to a complicating 
meningitis. All the symptoms disappear with 
the advent of the crisis, when the fever sud- 
denly abates and fails to rise again. The crisis 
may be expected any time between the third 
and eleventh day of the recovery cases. In the 
majority of my cases it has occurred from the 
fifth to the seventh day, in a few not until 
the ninth day, and in two it did not occur 
until the eleventh day, and in one on the four- 
teenth day. 

The prognosis of lobar pneumonia in chil- 
dren is good. A very small percentage fail to 
recover. A patient of mine, a three-year-old 
boy, passed through two distinct attacks in a 
single winter, the second after an interval of 
ten weeks. 

Broncho-pneumonia. — In catarrhal or bron- 
cho-pneumonia the story is different. There 
may be a pneumonia at the commencement of 
the illness, but according to my observation, 
which covers several hundred cases, the ma- 



Pneumonia 173 

jority begin with sypmtoms of a common cold 
or bronchitis, the lungs becoming involved 
gradually. In other words, the onset is grad- 
ual, not sudden, whether it occurs indepen- 
dently or as a complication of some other 
disease. There is cough, often distressing, 
moderate fever, rapid breathing, loss of appe- 
tite, and later, emaciation. Broncho-pneu- 
monia in children is an affection of extreme 
gravity. There is no well-defined crisis as in 
lobar pneumonia. The disease may last a week 
or two weeks, or it may continue for months. 
In one of my cases — a child eighteen months 
of age, — the disease continued three months 
before the low fever abated and the lungs were 
clear. The recovery cases often require from 
three to four weeks before the lungs may be 
considered normal. 

Care and prevention. — The sick-room of a 
patient ill with pneumonia should be large, 
with one window open at least four inches 
from the top on the coldest days. The tem- 
perature of the room should not be below 55 
F. or above 65 ° F. The child should be put 
on a reduced diet of animal broths, thin gruels, 
and diluted milk. 

Prevention resolves itself into proper care 



174 The Contagious Diseases 

of the child, proper clothing, avoidance of 
unnecessary exposure, and an appreciation of 
the fact that with a child it is almost as neces- 
sary to call a physician for a common cold or 
bronchitis as it is for scarlet fever or diph- 
theria. 

THE CONTAGIOUS DISEASES 

A contagious disease is one due to a specific 
poison which under favoring conditions pos- 
sesses the power of reproducing itself in the 
person of another. The poison of the disease, 
the contagium, may be transmitted either di- 
rectly by contact with an individual suffering 
from the disease, or indirectly by means of 
some person or object, such as the clothing 
or hands of the attendants, which have been 
in contact with the one infected. According 
to my observation, personal contact with the 
infected is required in a large proportion of 
cases. Measles and whooping-cough are un- 
questionably the most contagious diseases of 
this type, requiring for their transmission only 
a very slight exposure. German measles and 
chicken-pox are next in order of communica- 
bility, while scarlet fever is less contagious 
than any of those mentioned — a close contact 



Scarlet Fever 175 

and a fairly long exposure being usually re- 
quired. Clothing may be infected by the con- 
tagium of scarlet fever and diphtheria, the 
poison remaining inactive for a long time. 

Incubation period. — By this we understand 
the time usually required for the disease to 
develop after exposure. 

Diphtheria variable. 

Scarlet fever five to seven days. 

Measles nine to twelve days. 

Whooping-cough . . . seven to fourteen days. 

Chicken-pox fourteen to twenty-one days. 

Mumps ten to twenty days. 

German measles.. . .two to three weeks. 

Diphtheria through personal contact alone 
is probably the least contagious of any of the 
diseases belonging in this group. Its virulence, 
however, renders every preventive measure 
imperative. 

Smallpox, thanks to compulsory vaccination, 
is seen so rarely that it need not be considered 
here. 

SCARLET FEVER 

Scarlet fever is one of the most important 
of the contagious diseases, and whether a case 
is mild or severe it requires the greatest watch- 



176 Scarlet Fever 

fulness on the part of both physician and nurse, 
nor can their vigilance be safely relaxed until 
the patient has been apparently well for at least 
five or six weeks. 

Incubation. — The period of incubation 
varies considerably. In the majority of cases 
the first sign of trouble is noticed from three 
to five days after exposure. In one of my 
cases twelve days elapsed between the time of 
exposure and the initial symptom. If, how- 
ever, nine days pass without evidence of ill- 
ness, the child may ordinarily be considered 
safe, but the exposed should not come in con- 
tact with other children until at least four- 
teen days have elapsed. Infection usually 
takes place from direct contact, although the 
contagium, the nature of which is unknown, 
may be carried by means of clothing, toys, 
books, or a third person. Doctors who do not 
wear gowns while attending scarlet fever pa- 
tients, and are careless about washing their 
hands after examining such cases, may them- 
selves carry the disease. One attack usually 
protects against a second, although cases are on 
record of the occurrence of two or three at- 
tacks in the same individual. 

The onset. — The onset of scarlet fever is 



Scarlet Fever 177 

sudden, often with vomiting, occasionally with 
a convulsion, always with fever and sore 
throat. The fever is usually high, 103 to 
105 F., though it may be low, — 101 to 102 
F. When the latter is the case the course of 
the disease will probably be mild. Whether 
the fever is high or low, the deeply red, con- 
gested throat is usually present. 

The rash. — From twenty-four to thirty-six 
hours after the initial symptom the rash makes 
its appearance. In many mild cases it will be 
the first symptom noticed. The character of 
the rash, its intensity, and the height of the 
fever indicate fairly well the severity of the 
attack. The chest and abdomen are usually 
the site of the first appearance of the rash. It 
is composed of minute red dots so closely set 
together as to give the skin a deep scarlet color. 
The extent of the rash varies greatly; in some 
cases it covers the entire body and lasts from 
six to seven days. In others, it is much less 
distinct, covering only limited areas, and may 
last for only a few hours. In one of my cases 
it was visible for only six hours after it was 
first noticed; while in all other respects the 
case was one of typical scarlet fever. 

Desquamation. — Ordinarily the rash begins 



178 German Measles 

to fade about the fourth or fifth day and is 
followed by the desquamation period. This 
is also variable in extent; there may be but 
a light peeling of the palms of the hands, and 
of the finger-tips about the nails, or it may 
be most profuse, the epidermis peeling off in 
large flakes from the entire surface of the 
body. From two to three weeks are required 
to complete this process. 

Complications. — Complications are a com- 
mon occurrence in scarlet fever, and it is the 
complications which are usually the cause of 
death in the fatal cases. The kidneys, heart, 
lungs, and ears are particularly liable to seri- 
ous involvement. 

An error frequently made is to allow the 
child convalescent from scarlet fever to be out 
of bed too early. He should never be allowed 
to run about before four, or, better still, five or 
six weeks have elapsed. The peeling may be 
hastened, the disease curtailed, and the danger 
of spreading lessened by a daily sponge bath fol- 
lowed by an inunction with sweet oil or vaseline. 

GERMAN MEASLES 

German measles is a contagious disease of 
a very mild type, ordinarily the rash being 



Mumps 179 

the symptom of illness. This may have been 
preceded, however, by a slight chilliness and 
soreness of the muscles. The eruption is of 
a reddish-brown color and appears more ex- 
tensively on the face and chest than on other 
parts of the body. The spots vary in size from 
a pin-head to a flaxseed. In well-developed 
cases the rash may cover the entire surface of 
the body. The temperature is usually low and 
lasts but a day or two. I have never seen it 
above 102 F. There is little or no inflamma- 
tion of the eyes, nose, or throat, in marked con- 
tradistinction to measles. There is no cough 
and the child suffers very little inconvenience. 
The glands behind the ear and at the sides of 
the neck are almost always enlarged and sensi- 
tive, — this with the fever and the rash com- 
prising the chief symptoms of the disease. 
The duration of the rash varies from one to 
three days. Usually at the end of forty-eight 
hours the skin will be found clear. 

My treatment is : two or three days in bed 
and a light diet. 

MUMPS 

Mumps is an inflammation of one or both 
parotid glands. One attack usually protects 



180 Mumps 

against another. The disease is usually ac- 
quired by contact with the infected. It is ex- 
tremely doubtful that it can be carried by a 
third party. The period of time required for 
the development of the disease after exposure 
varies considerably; but from ten to twenty 
days may be considered the period of incuba- 
tion. 

The first symptoms are similar to those 
of the other contagious diseases. There is 
loss of appetite, headache, languor, and slight 
fever. In addition to these general symptoms, 
the child complains of pain upon swallowing, 
or upon moving the jaw. Vinegar or any acid 
substance taken into the mouth causes con- 
siderable pain or discomfort behind the jaws 
and under the ears. In a few hours there will 
be noticed a swelling of the parotid gland in 
front of and under the ear. Both sides rarely 
begin to swell at the same time ; the swelling of 
one gland usually precedes that of the other by 
a couple of days. It increases gradually for 
two or three days until it reaches its height, 
when it begins to subside slowly, reaching the 
normal in eight or ten days from its beginning. 
The temperature during the attack ranges from 
ioo° to 103 F. 



Mumps 181 

The complications of mumps in children are 
few, and the disease cannot be regarded as 
dangerous. Acute Bright's disease followed 
an attack of mumps in one of my patients. 
Swelling of the testicles is a comparatively 
rare occurrence. Ear disease is an infrequent 
but possible complication. Multiple abscesses 
may develop in the parotid gland, but this is 
also a very rare occurrence. Other acute 
glandular swellings at the angle of the jaw 
are often mistaken for mumps; in mumps, 
however, the swelling is always in front of, 
under, and behind the ear. A simple glandu- 
lar enlargement may be located at any point 
under or behind the jaw. 

Management. — A child with mumps should 
be kept in bed until the swelling has subsided, 
and given plain, easily digested food. The 
mouth should be rinsed after each meal with 
a saturated solution of boracic acid. For the 
pain and discomfort caused by the swelling, 
hot applications answer best. Flannel wrung 
out of very hot water and bound upon the parts 
always furnishes some relief. The flannel 
should be kept hot by repeatedly dipping it into 
hot water. The heat will be retained better if 
the flannel is covered with oiled-silk. 



1 82 Whooping-Cough 

WHOOPING-COUGH 

In whooping-cough we have one of the most 
dangerous diseases of childhood, dangerous in 
the extreme for the very young, the delicate, 
and the rachitic. In itself it is seldom directly 
fatal, but the frequent complications of 
catarrhal pneumonia in winter and intestinal 
diseases in summer make it indirectly responsi- 
ble for the loss of many lives. 

The period of incubation ranges from seven 
to fourteen days. At the commencement of 
the disease the cough is not severe and often 
cannot be distinguished from that of bronchitis 
or a common cold. The cough, however, does 
not respond to treatment for coughs and colds ; 
it increases in severity, becoming paroxysmal 
in character and worse at night. During the 
paroxysms the eyes water, the face becomes 
red and congested, the seizure often ending in 
vomiting. The characteristic whoop usually 
develops after ten days or two weeks. In the 
mild cases there may be but two or three 
paroxysms daily; in the severe cases there are 
usually from twenty to thirty in twenty-four 
hours. I have seen a few cases in which the 
disease was so mild that the whoop never ap- 



Whooping-Cough 183 

peared, while others whooped but once during 
an entire attack. The disease varies not only 
in its severity, but in its duration as well. Oc- 
casionally cases are seen which run the entire 
course in four weeks; unfortunately, they are 
rare. As a rule, from eight to ten weeks elapse 
before the child may be considered well. 

As long as the child continues to whoop, or 
the cough is distinctly paroxysmal, it is not 
safe for him to come in contact with the un- 
protected. The active stage, during which the 
paroxysms are frequent and severe, rarely lasts 
longer than two or three weeks. 

Recurrence of the whoop. — Sometimes after 
a period of three or four months without 
whooping, the child takes cold, develops a 
cough paroxysmal in character, and the whoop 
returns ; but this does not mean that there is a 
return of the whooping-cough, and such chil- 
dren need not be quarantined. 

Management. — Whooping-cough cannot be 
cured; it must run its course. Much may be 
done, however, to relieve it, by the use of the 
pertussis vaccines. This treatment can only 
be applied by a physician who should be con- 
sulted early in the attack or if the child has 
been exposed. Other than this the home treat- 



1 84 Diphtheria 

ment demands an abundance of fresh air. The 
child should spend the greater part of every 
pleasant day out of doors and sleep with the 
window open an inch or two from the top, re- 
gardless of the weather. 

There are certain drugs which appreciably 
relieve the paroxysm, but they must always be 
ordered by a physician. 

DIPHTHERIA 

Diphtheria is a disease due to a germ which 
is known as the Klebs-Loeffler bacillus. The 
mucous membrane of the throat or nose are 
the parts primarily attacked. The disease is 
usually of slow and insidious onset, requiring 
two or three days for its complete development. 
The period of incubation varies greatly: a 
child may develop diphtheria within twenty- 
four hours after exposure, or it may be delayed 
a month or six weeks. In children who have 
been exposed, there should be a microscopical 
examination of the secretion from the throat, 
which may settle the question as to the child's 
liability to contract the disease. 

The first symptoms are fever and restless- 
ness, loss of appetite, and disinclination to play. 



Diphtheria 185 

The child may complain of pain upon swallow- 
ing, and in many cases, very early in the at- 
tack, swelling many be noticed at the angle of 
the jaw. Inspection of the throat shows the 
characteristic patches of the membrane. In 
some cases these patches resemble a thin layer 
of putty spread over the parts. Others present 
the appearance of a very light-yellow paint 
splashed upon the tonsils and adjacent parts. 
The membrane may be located in the nose, 
throat, larynx, eye, — in fact, any mucous sur- 
face may become infected; fresh wounds may 
also become infected. The usual sites, how- 
ever, are the nose, throat, and larynx. 

Transmission. — The disease may be trans- 
mitted by direct contact, by means of contami- 
nated clothing, toys, pictures, books, or the 
germs may be carried on the hands or clothing 
of an attendant. 

Recurrence. — One attack does not protect 
against another. There is evidence that a cer- 
tain degree of immunity is established, but it 
probably is not effective for more than a few 
months. Diphtheria does not run a definite 
course, like the other infectious diseases. We 
cannot say that certain definite signs will be 
present on certain days. It is the most uncer- 



1 86 Diphtheria 

tain and treacherous disease with which we 
have to deal. 

Management. — The only treatment of value 
other than supportive measures is the use of 
antitoxin, which must be given early in the 
disease — as soon as a diagnosis of diphtheria 
is made. In fact, I believe it is advisable to 
give it in all cases where there is any uncer- 
tainty as to whether the case is tonsillitis or 
diphtheria. Much valuable time may be lost 
by delay. The dosage and frequency of ad- 
ministration of antitoxin must be determined 
according to the nature of the case by the at- 
tending physician. During convalescence, the 
child must not be allowed to mingle with other 
children until a bacteriological examination of 
the throat shows it to be free from diphtheritic 
germs. 

The instructions for the preparation of the 
sick-room, for disinfection and quarantine, will 
be found on pages 1 91-194. 



CHICKEN-POX 

Chicken-pox is one of the milder contagious 
diseases. Among several hundred cases I have 
seen but two that were severe enough to endan- 
ger life. 

The period of incubation is quite long, — 
from fourteen to twenty-one days. There is 
slight fever at the onset, rarely high enough, 
however, to be noticed by the mother or nurse. 
More frequently the first sign of the disease 
is the characteristic eruption, which may ap- 
pear on any portion of the body, the scalp 
sometimes being particularly involved. The 
rash consists of very small blisters which from 
a distance give to the skin the appearance of 
having been sprinkled with water. The fluid 
soon disappears, leaving a dark-colored crust. 
When the crusts fall, a small scar is often left, 
which may remain for several months. In an 
ordinary case the skin will not be clear before 
the end of the third or fourth week. 

Management. — The child should be kept in- 
doors during the attack, and given a reduced 
187 



188 Measles 

diet. The itching is often relieved by sponging 
with a weak solution of alcohol in water, — 
four ounces to a pint, — followed by a gentle 
application of vaseline. 

I never advise quarantine against chicken- 
pox except to avoid needless exposure of very 
young or delicate children in the family. The 
patient should not return to school or be al- 
lowed to mingle with other children — in short, 
is not to be considered well — until the skin is 
clear. 

MEASLES 

The incubation period of measles — the time 
required between the exposure and the develop- 
ment of the first symptom — varies between nine 
and twelve days. One attack usually protects 
against a second. This, however, is not invari- 
ably the case. 

The onset of the disease closely resembles 
that of a common cold. The symptoms are 
slight fever, ioo° to 102 F., redness of the 
eyes and intolerance of light, a watery dis- 
charge from the nose, a dry, hard cough, pain 
on swallowing, and loss of appetite. The pecul- 
iar swollen, congested condition of the eyes 



Measles 189 

and face often makes a diagnosis possible be- 
fore the appearance of the rash. 

Rash. — This usually first appears, from the 
second to the fourth day of the illness, upon the 
face and chest. At first there are small, irregu- 
larly shaped spots said to resemble fleabites. 
The spots coalesce, the rash extends, and in 
one or two days the greater portion of the skin 
is involved. The rash remains at its height 
for two or three days, when it begins to fade, 
and in two or three days more the skin becomes 
clear. With the subsidence of the rash, 
desquamation or peeling of the skin begins. 
This consists in the shedding of fine, thin 
scales. The fever and prostration keep pace 
fairly well with the rash. 

Fever. — The fever, which may range be- 
tween 102 and iO5 F., reaches its highest 
point with the complete development of the 
rash. With the fading of the rash the fever 
also moderates. 

Cough and bronchitis. — The cough in mea- 
sles is hard and dry in character and is often 
quite severe. It must be remembered that the 
congestion of the respiratory mucous mem- 
brane which causes the cough is a part of the 
disease. The cough may be relieved, but it 



190 Measles 

will not subside until the disease has run its 
course. In many families but little attention is 
paid to measles — it is regarded with more or 
less indifference. While, in most instances, 
the disease may not be particularly dangerous, 
we must remember that it is sometimes quite 
virulent, and domestic treatment should never 
be relied upon. There is always more or less 
bronchitis, which in young and delicate infants 
constitutes a severe complication, leading, as 
it often does, to catarrhal pneumonia. 

The eyes. — There is always considerable in- 
volvement of the eyes, the lids being red and 
swollen, with a free secretion of watery mucus. 

Management. — The eyes should be washed 
three or four times daily with a saturated solu- 
tion of boracic acid, a tablespoonful to one pint 
of boiling water. Their sensitive condition 
requires also a darkened room, and failure to 
appreciate this fact has often resulted in their 
permanent injury. A darkened room, how- 
ever, does not mean a room devoid of ventila- 
tion; fresh air for a patient with a contagious 
disease is almost as important as nourishment. 
The diet must be simple ; only fluid diet should 
be given to "runabouts," while for infants the 
usual milk mixture should be diluted with 



The Sick-Room 191 

boiled water from one-third to one-half. A 
sponge bath two or three times daily using one 
tablespoonful Bicarbonate Soda in half a gal- 
lon of water followed by an inunction with 
vaseline will furnish great relief from the itch- 
ing and renders the patient generally much 
more comfortable. 

Children convalescent from measles should 
not be allowed to go to school or mingle with 
the unprotected until two weeks after the com- 
pletion of desquamation. 

SICK-ROOM FOR CONTAGIOUS 
DISEASES 

QUARANTINE 

A child ill with a contagious disease should 
always be isolated, whether there are unpro- 
tected children in the family or not. Quaran- 
tine can be carried out only when the child is 
placed in a room alone with the nurse or 
mother, and neither allowed to leave the room 
or in any way to come in contact with other 
members of the family. If possible the room 
should be on the top floor of the house. The 
furniture should be of the simplest, — no fancy 
curtains and no upholstery. A perfectly bare 



192 The Sick-Room 

floor is best. If two nurses are required, two 
isolating rooms will be necessary, one to be 
used as a sleeping-room. The meals should be 
carried on a tray and placed upon a chair out- 
side the closed door of the isolating room. The 
dishes containing the food are to be removed 
by the person isolated. After use, before 
returning the dishes to the chair outside the 
door, they should be placed for five minutes 
in boiling water. Only wash goods should 
be worn by the attendants, and their clothing, 
with bed linen when changed, should be placed 
in boiling water — one ounce of carbolic acid 
to two gallons of water — before it is sent to 
the laundry. 

When other members of the family are al- 
lowed to go at will into and out of the isolating 
room, the value of the quarantine is practically 
lost. If the illness is of a serious nature, such 
as scarlet fever or diphtheria, the other chil- 
dren of the family should be sent to other 
quarters; particularly should this be done if 
the family occupy an apartment. 

DISINFECTANT DRUGS 

The erroneous views possessed by many 
concerning disinfection often result in much 



The Sick-Room 193 

harm. Too many are satisfied by the use of 
disinfectant solutions and drugs at the expense 
of cleanliness. Any agent that will destroy 
germs is a disinfectant. Disinfection really 
means cleanliness. Disinfectants can never 
supplant hot water, common yellow soap, and 
a nail-brush. Dipping the hands into a solu- 
tion of carbolic acid or bichloride of mercury 
will not make them clean, much less sterile. 
Sprinkling either of these substances upon the 
floor will not clean the floor or be of one par- 
ticle of service. Scrubbing the floor of the 
sick-room once a day, using hot water, sapolio, 
and a stiff brush, will do more to prevent the 
circulation of the germ-laden dust than any 
disinfectant which can be used. I recently 
saw a young mother change the baby's napkin, 
immediately after which, with hands un- 
touched by soap or water, she very carefully 
washed out the baby's mouth with a boracic 
acid solution ! The young mother was anxious 
to do her full duty by the child, but had never 
learned the rudiments of disinfection. 

Disinfectant solutions and drugs are of 
much service when used after a thorough 
scrubbing with hot water, soap, and brush, — 
never before. 



194 Disinfection 

DISINFECTION AFTER CONTAGIOUS 
DISEASES— FUMIGATION 

Before being allowed to resume his place 
in the family, the child who has recovered 
from a contagious disease should be given a 
tub-bath, with a vigorous scrubbing with soap 
and warm water. The hair should be washed 
with a i to 2000 solution of bichloride of mer- 
cury, and the child dressed in fresh clothing 
outside the sick-room. 

The soiled clothing and the bedding which 
can be washed should be put into a solution 
of one ounce of carbolic acid to two gallons 
of water. The vessel should be covered and 
removed to the laundry and the clothing boiled 
thirty minutes. The bedding and such articles 
as cannot be washed should be spread over the 
furniture in readiness for fumigation. 

The windows and doors must be closed and 
sealed, when the room can be fumigated with 
sulphur or formalin. If sulphur is used, three 
pounds of roll sulphur are required by the 
New York Health Department for every thou- 
sand cubic feet of air space. The sulphur is 
placed in an iron vessel which, as a precaution 
against fire, should stand on a large piece of 



Fumigation 195 

tin or zinc. Alcohol is poured over the sul- 
phur and ignited, after which the room should 
not be opened for twenty-four hours. If the 
air in the room can be charged with a moderate 
amount of vapor from an open vessel on a 
stove or radiator, the sulphur disinfection will 
be more complete. Formalin acts as a much 
better disinfectant and is far less objectionable 
than sulphur. Formalin candles for disinfect- 
ing purposes may be found in all drug stores. 
After the fumigation, the carpet or rugs, 
mattresses and pillows, are taken charge of 
by the health authorities in the larger cities, 
steamed, and returned in two or three days 
free of expense to the owner. Otherwise such 
articles should be sent to the cleaner and the 
mattresses and pillows re-covered. The floor 
of the room and the woodwork should be 
scrubbed with hot water, brush, and soap. 
When dry they should be washed with a i to 
2000 solution of bichloride of mercury. The 
furniture should also be washed with the 
bichloride solution. If the walls are papered, 
they should be wiped with cloths moistened 
with this solution; but it is better to have the 
room re-papered. If the walls are painted, 
they should be washed with the solution. If 



196 The Delicate Child 

the walls can be newly papered, painted, or 
kalsomined, much greater security will be en- 
joyed by the future occupant. 

THE DELICATE CHILD 

In work among children one frequently 
meets with those who, while they cannot be 
said to be suffering from any disease or 
pathologic condition, yet are inferior in 
physical development, lack endurance, and 
possess poor resisting powers. They are 
often under height, always under weight, and, 
in short, have so many characteristics in com- 
mon that they constitute a class by themselves, 
and as such warrant our attention. 

Normal development. — The average child, 
at the various periods of early life, conforms 
with a certain degree of regularity to the 
physical development which by long asso- 
ciation we have come to regard as normal. 
Thus a standard may be said to have been es- 
tablished, and it is up to this standard that we 
expect the growing child to measure. (See 
page 9.) This is what we look upon as 
the average of physical development. A 
few children exceed these requirements : 



The Delicate Child 197 

they are stronger and larger at the sixth 
month than the average child at the ninth 
month. Again, older children at the fourth or 
fifth year are in every way equal to their nor- 
mal playmates a year or two older. 

Abnormal development. — On the other hand, 
there are children who are born with a re- 
duced vitality, or who, through faulty man- 
agement, usually in relation to feeding, 
acquire a reduced vitality. Semi-invalid 
adults almost invariably beget semi-invalid 
children. If the parents are of average health 
and of good habits, and the debilitated condition 
of the child is due to faulty management and 
nutritional errors, the result of proper dietetic 
and hygienic management is usually prompt 
and satisfactory. With the persistently deli- 
cate, the offspring of physically enfeebled 
parents, the results are less satisfactory, but 
improvement is always possible. 

Management. — By proper regulation of the 
habits of a delicate child, as regards all the 
details of his daily life, a far better adult is 
produced than if no such effort had been made. 
In other words, a diet and general regime of 
life best adapted to the individual in question 
will invariably improve the physical condition 



198 The Delicate Child 

of that individual. This applies to the strong 
as well as to the delicate, to the growth and 
development of the young of the lower animals 
as well as to the offspring of man. It is the 
poorly developed, delicate child that we are 
particularly to consider — the undersized, frail, 
small-boned, under-weight child, whose appe- 
tite is persistently poor or capricious, who 
sleeps poorly, tires easily, is usually constipated, 
who is subject to catarrhal conditions of the 
respiratory tract, and whose powers of re- 
sistance generally are diminished. In not every 
delicate child will all these symptoms be found. 
Under-weight and one or more of the other 
conditions referred to will usually be present. 
On assuming the management of one of 
these children it is absolutely necessary to make 
a thorough examination, followed in some in- 
stances by a few weeks' observation, in order 
to become acquainted with the case in its indi- 
vidual aspects, to learn idiosyncrasies, and to 
eliminate the factor of actual disease as a 
causative agent. When we demonstrate to 
our satisfaction that the child is free from such 
diseases as tuberculosis, kidney disease, and 
malaria; when we have eliminated by properly 
directed treatment all causes, such as adenoids, 



The Delicate Child 199 

phimosis, adherent clitoris, vaginitis, or parasi- 
tic and irritant skin lesions, which may have 
had a deterrent influence upon growth; and 
when we have satisfied ourselves as to the 
actual condition of our patient, we are in a 
position to lay down definite rules of manage- 
ment. 

Every child has a distinct function to per- 
form. As soon as he is born he is confronted 
with a serious problem — the problem of 
growth, physical and mental. Inasmuch as 
this growth and development depend, above 
all things, upon a properly adapted food sup- 
ply, it must be our first step to provide such 
nutriment as will be most conducive to it. As 
growth takes place in all parts of the body 
through cellular activity, the nutritive elements 
which support cell proliferation must be im- 
portant constituents of the diet, and among 
these the proteids are of prime importance; 
hence in the management of these children a 
point to be remembered in the adaptation of the 
food is the necessity of feeding as rich a 
proteid as the child can assimilate. The 
younger the child, the greater the necessity 
for growth. 

Regular weighings necessary. — An infant 



200 The Delicate Child 

should be weighed at regular intervals, and 
if under one year of age, should not be con- 
sidered as doing even passably well if not gain- 
ing at least four ounces weekly. When a baby 
remains stationary in weight its development 
is invariably abnormal. When stationary or 
when only a slight gain of one or two ounces 
weekly is made, we will always find after a 
few weeks that there is malnutrition, in spite 
of the apparent gain, as will be evidenced by 
the symptoms of beginning rickets — anaemia, 
the characteristic bone changes, flabby muscles, 
and a tendency to disease of the mucous mem- 
branes. Delicate infants should be weighed 
daily at first ; then, as improvement takes place, 
at intervals of two or more days, but never 
less frequently than once a week, if under one 
year of age, no matter how vigorous they may 
become. The weighing keeps us directly in 
touch with the child's condition, but since the 
increase may be in fat alone, an occasional ex- 
amination of the child stripped is necessary 
to tell us whether there is substantial growth 
in bone and muscle. 

Feeding delicate infants. — When it is dem- 
onstrated that a child will not thrive on the 
breast of the mother, another breast should be 



The Delicate Child 201 

substituted, or an adapted high-proteid cows' 
milk should form the diet in part or in whole. 
If the child is bottle-fed and it is demonstrated 
that proper growth and development are im- 
possible on cow's milk, on account of proteid 
incapacity, then a wet-nurse should be secured. 

When, after the first year, more liberal feed- 
ing is allowed, the necessity for a high proteid 
in the food selected is as urgent as before. 
This applies to those children who are brought 
to us showing evidences of late malnutrition, 
as well as to those whom we have had under 
our care from early infancy. 

An important element in the diet up to the 
third year, is milk. Unfortunately, many de- 
bilitated children have a very poor capacity 
for fat assimilation. When given full milk 
in as small an amount as one pint daily, they 
often develop foul breath, coated tongue, and 
loss of appetite, or they suffer from frequent 
attacks of acute indigestion. The milk is 
necessary, not because of the fat, which can 
easily be dispensed with, but because of the 
high percentage of proteid which it contains — 
from three to four per cent. When this fat 
incapacity exists, the milk is said to "disagree," 
but skimmed milk will be taken without incon- 



202 The Delicate Child 

venience. Enough sugar may be added to 
bring the percentage up to seven, in order that 
it may replace the fat, for fuel. Skimmed 
milk with sugar added furnishes a food of 
no mean order. Too much milk, however, 
must not be given. When large quantities, 
more than one quart daily, are taken, the desire 
for more substantial nourishment, such as 
eggs, meat, and cereals, is removed. 

At the completion of the first year, keeping 
in mind a high proteid, begin with scraped 
beef, at first one teaspoonful once a day, in 
addition to the cereal and milk. If this is well- 
borne, and it usually is, a teaspoonful may be 
given twice a day, and later three times a day. 
It may be given immediately before the bottle- 
feeding. Eggs should be brought into use 
from the twelfth to the fifteenth month. At 
first one-half an egg, boiled two minutes, is 
given mixed with bread-crumbs. If well borne, 
a whole egg may be allowed. The cereals used 
should be those most rich in vegetable protein, 
such as oatmeal, containing 16 per cent, of 
proteid, dried peas, 20 per cent, of proteid, and 
dried beans, containing 24 per cent, of proteid. 
The peas, beans, and lentils should be given in 
the form of a puree. 



The Delicate Child 203 

Diet after the first year. — If the child during 
the second year has an indifferent appetite, 
reduce the quantity of milk; never al- 
low more than one pint of milk daily 
for the first week or two under treat- 
ment. Many delicate children who apply 
for treatment after the first year of age 
have been subjected to as grave errors in diet 
as are seen among the bottle-fed. Starch foods 
and milk oftentimes furnish the only means 
of nutrition up to the fourth or fifth year, the 
starch used being generally in the form of 
bread, crackers, and indifferently cooked 
cereals. In one case four quarts of milk were 
taken daily by a boy of seven years. 

It will be seen that it is our aim in this class 
of children — the delicate, undersized, slow- 
growing class — to give as liberal a nitroge- 
nous nourishment as is compatible with 
the digestive capacity of the patient. But 
if the child has had rheumatism, or if 
there is a tendency to lithiasis, the use 
of a large amount of meat is contra- 
indicated. It is in such children that the high- 
proteid cereals are particularly valuable. In 
a general way, from early life the diet of the 
delicate child should consist of milk, suitably 



2o 4 The Delicate Child 

adapted, with highly nitrogenous cereal added, 
when permissible. Many delicate children of 
the "runabout" age who cannot digest milk 
containing 4 per cent, of fat will easily digest 
butter fat when spread on bread or potatoes. 
In this way I often use it to supply fuel to act 
as a proteid-sparer. Oatmeal-water or oat- 
meal-jelly, mixed with the milk, should be 
ordered at the seventh month. When age al- 
lows, the addition of raw meat, poultry, eggs, 
and purees of dried peas, beans, and lentils 
should be given. Boxed "ready to serve" 
cereals are never given; raw* cereals are used, 
which are cooked three hours. While a high- 
proteid diet is desirable, other things are neces- 
sary. Green vegetables, animal fats, the 
ordinary cereals, cooked and raw fruits, are re- 
quired to furnish the necessary acids and salts, 
as well as the necessary variety. In short, the 
ideal diet for a delicate child is that combina- 
tion of food which, while imposing the least 
burden upon the digestive organs, supplies the 
body with material exactly sufficient for its 
needs, and such a food must be rich in nitro- 
gen. (See dietary, page 71.) 

Baths. — On account of the fear that a deli- 
cate child may take cold, the bath is often 



The Delicate Child 205 

omitted. Every child, both the well and the 
delicate, after the second week should be 
tubbed daily. The delicate particularly require 
it. The brine bath (page 115) is usually ad- 
vised. The best time for giving the bath is at 
bedtime, and in order to avoid all chance of 
exposure the temperature of the room should 
be elevated to 8o° F. The temperature of the 
water may vary. It should never be above 95 
F. except for very delicate young children in 
whom there is a tendency to a subnormal tem- 
perature. Even in these cases the temperature 
of the bath should never be higher than the 
temperature of the body. In the frail and in 
the very young the bath should not be con- 
tinued over five minutes. In older children, 
those of eighteen months or over, if the physi- 
cal conditions allow, a distinct advantage will 
be gained by a reduction of the temperature 
of the bath while the child is in the water. An 
immersion in water at 90 F. followed by a 
gradual reduction during the space of five or 
six minutes to 70 F. should, upon brisk rub- 
bing, be followed by a quick reaction. If the 
reaction is not good, if the extremities are cold 
and are slow in becoming warm, the reduction 
in the temperature should be less or none at all. 



206 The Delicate Child 

In the very poorly nourished, a reduction below 
8o° F. should not be attempted. Following the 
drying process, primarily for the benefit of 
the massage, goose oil or olive oil should be 
rubbed into the skin over the entire body for 
from five to ten minutes. The bath and the 
massage inunction, besides favorably influenc- 
ing nutrition, are a very effective means of 
inducing sleep. 

Fresh air. — Delicate children are usually de- 
prived of a proper amount of fresh air, for the 
same reason that they are insufficiently bathed 
— the fear of making them ill. All children 
need an abundance of fresh air, both in illness 
and in health. The robust and the delicate re- 
quire it, and to the delicate it is much more 
essential than to the robust. As many hours 
daily as practicable should be spent out of doors. 
The time thus spent depends upon the season 
of the year and the residence of the child, 
whether in the city or the country. In the city, 
during the colder months with pleasant 
weather, the child should spend at least five 
hours daily in the open air, dividing the day 
into two outing periods — from 9 to 1 1 130 in 
the morning and from 2 to 4 130 in the after- 
noon. On very cold days, 20 F. or below, 



The Delicate Child 207 

on stormy days, and on days with very high 
winds, the child is given his airing indoors. 
He is dressed as for out of doors, placed in his 
carriage, and left in a room, the windows on 
one side of the room being open. Not infre- 
quently during February and March delicate 
children will be prevented from going out of 
doors for several consecutive days. If some 
means for a daily systematic indoor airing is 
not provided, these children will often go back- 
ward, no matter how excellent the other man- 
agement. The first symptoms are loss of ap- 
petite and the ability to assimilate the food. 
In my private work among marasmus cases, 
the child is placed in the baby-carriage or in a 
basket and allowed to rest before an open 
window for ten or twelve hours of every 
twenty-four, with a hot-water bottle at his feet. 
Here he is fed, being removed only tem- 
porarily to warmer quarters for a change of 
napkins. I have several roof gardens in opera- 
tion. A boy patient nine months of age has 
been in the street only once in four months, 
then only in going to church to be baptized. 

Sleep. — The delicate child requires no 
more sleep than does the strong, and the rules 
governing this matter at the various periods 



208 The Delicate Child 

of life are the same both for the strong and 
for the weak. (See Sleep, page 282.) The 
sleeping-room of the delicate child should al- 
ways communicate with the open air by a win- 
dow, either directly or through an adjoining 
room. A satisfactory method of ventilation 
is by the window-board (page 16). The child 
should occupy the room alone, if possible, 
sharing it neither with an adult nor another 
child. This applies to all ages, but is particu- 
larly necessary after the second year. 

The nursery. — The temperature of the 
nursery, day or night, should never be above 
70 F., during the colder months, and in the 
case of the very young, or in those who are 
difficult to keep covered, it should not go be- 
low 65 ° F. at night. 

Delicate children of the "runabout" age are 
very susceptible to colds. In the management 
of such children it is necessary to use every 
precaution against exposure. The most fre- 
quent way of exposing a child to cold is by 
allowing him to sit on the floor. To keep the 
child of from ten months to three years of age 
off the floor during the winter months, and 
thereby to eliminate this means of exposure, 
is a very difficult matter. In fact with active 



The Delicate Child 209 

children, learning to walk, or who have just 
learned to walk, it is practically impossible un- 
der the usual conditions. During the colder 
months there is always a current of cold air 
near the floor, and allowing the child to creep 
in winter, even if the floor is protected by rugs 
and carpets, is one of the surest ways of per- 
mitting him to take cold. If he is allowed to 
walk on the floor he is soon very sure to sit 
down. If he is not allowed to creep and walk 
about at will, he will not get the proper exer- 
cise and will show faulty development. For 
such cases I have found the exercise pen of 
immense service (see Fig. 21.). After being 
dressed, washed, and fed, the child is placed 
in the pen, on a rug if desired. Toys are given 
him and the door is closed. He can now roam 
about at will, stand up, sit down, creep, or walk 
without the slightest danger from drafts. 

Influence of climate. — Much has been writ- 
ten regarding the influence of climate in the 
type of case we are considering. According 
to my observation, this matter does not deserve 
the attention it has received. The city child 
in a well-to-do family is, as a rule, better off 
for eight months of the year in his own home 
with its usual conveniences. The benefits at- 



2io The Delicate Child 

tributed to change in climate are usually the 
result of a change not of climate but to more 
fresh air, which is afforded by the larger 
rooms of the hotel, with its loosely constructed 
doors and windows; and since the parent is 
desirous that the child shall receive the full 
benefit of the change, he is kept in the open 
air for a much longer time than when at home. 
The air at such a place is more expensive, and 
consequently more appreciated than the air at 
home. With sufficient heat and proper ventila- 
tion, we may make our own climate. It is not 
to be denied, however, that a change of resi- 
dence for a few weeks from New York to 
Lakewood or Atlantic City during March and 
April is sometimes of advantage. 

From the first of June to the first of Octo- 
ber the delicate child should not remain in New 
York City. The humidity and the heat which 
may prevail for protracted periods during this 
time render it unsafe, particularly during July 
and August. The seashore for the entire sum- 
mer is not to be advised. The children whom 
I have sent inland to the country and to the 
mountains have, as a rule, returned in the au- 
tumn in a much better physical condition than 
those who spent the summer by the sea. 



The Delicate Child 211 

Clothing. — Thin, poorly nourished children 
require more clothing than do those physi- 
cally normal. A fairly good index as to 
whether a child is sufficiently clad is the condi- 
tion of his lower extremities. The forearm 
and hand cannot be relied upon. The legs and 
feet of every child should always be warm to 
the touch. 

As to the nature of the clothing. — A mixture 
of silk and wool next to the skin is most de- 
sirable. As a second choice a mixture of wool 
and cotton is used. The linen mesh, often 
useful in the vigorous "runabout," is not to 
be advised in the delicate. 

Exercise. — Moderate exercise is to be en- 
couraged. But it should never be allowed 
to the point of fatigue. In large cities all deli- 
cate "runabouts" from three to five years of 
age should be allowed to walk not more than 
six blocks in going to the playgrounds. If the 
distance is greater, the child should ride part 
of the way, play or walk for a time, and then 
be placed in the carriage or cart and ride home. 
Younger children, two or three years of age, 
should be wheeled both ways and taken out at 
the park for a run when the weather conditions 
permit. 



212 The Delicate Child 

Midday nap. — Every day after the midday 
meal the child, regardless of age, whether two 
years or six, should be undressed and put to 
bed for two hours. He should be left alone 
in the room, and whether he sleeps or not he 
should remain in bed for the two hours. 

Entertainment. — Entertaining play is neces- 
sary, but every kind of excitement, such as 
children's parties, emotional plays at the 
theatre, and rough play with older children, 
should be avoided. 

Education. — The delicate child under eight 
years of age should be taught only to the ex- 
tent of strict obedience and good habits. Other 
than this he should be a little animal. There 
should be no teaching in the ordinary sense 
of the term, no mental stimulation, until the 
child is physically able to bear it. When 
school-work begins, which in this class of 
children should never be before the eighth 
year, the studies should be made easy and the 
school hours short. Such children should 
never be crowded. I usually direct that they 
attend only the morning session. 

The delicate child should be carefully 
watched from the time it comes into our hands 
until it reaches the normal or until the period 



Premature and Weak Infants 213 

of development is completed. While the 
scheme of management as outlined will not 
always be attended with brilliant results, it 
will not be in vain. Many lives will be saved, 
and as a result of the increased acquired re- 
sistance, stronger men and women will be 
added to the race than would otherwise have 
been possible. 

PREMATURE AND CONGENITALLY 
WEAK INFANTS 

There are comparatively few infants born 
before the completion of the twenty-eighth 
week of pregnancy that survive the first year. 
Reported cases of survival of those born be- 
fore that time are usually unreliable, as they 
seldom take the child beyond the third month. 
The prognosis is influenced by the factors 
causing the premature birth. 

Management. — In the management of the 
premature and delicate newly born there are 
three points to be considered — the air the child 
gets to breathe, the nourishment, and the main- 
tenance of bodily heat. It is also to be remem- 
bered that we are dealing with an undeveloped 
body which is not ready for the environment 



214 Premature and Weak Infants 

in which it is placed. The premature 
baby should be handled only when neces- 
sary, and then in the gentlest manner. Bath- 
ing is often best omitted for the first few 
weeks, oil being used for cleansing purposes. 
Because of the undeveloped parenchyma of 
the lungs unusually good fresh air is required. 
Because of the undeveloped heat-centres the 
body-heat of the premature infants is quickly 
lost and must be maintained by artificial means. 
The stomach is small and the digestive proc- 
esses are undeveloped and weak, so that the 
nourishment should be of the most easily as- 
similable character. 

Incubators. — The maintenance of heat is of 
the utmost importance. For this purpose 
incubators and their various modifications 
have been used from time to time. My experi- 
ence with incubators has been unsatisfactory. 
They may by careful watching maintain an 
even temperature, but all that I have used have 
been defective in supplying fresh air to the 
child. My incubator babies have usually done 
badly. Removal from the incubator was neces- 
sary. 

The electrotherm. — If the electrotherm 
(Fig. 12) is not at hand, the padded crib with 



Premature and Weak Infants 215 

the child wrapped in cotton and surrounded 
by hot-water bottles is the best means of main- 
taining the temperature. A thermometer 
should rest between the cotton and the bed- 
clothing as a guide to the nurses in the use of 




FIG. 12. THE ELECTROTHERM 



the hot-water bottles. Ordinarily this should 
register from 85 to 95 F., depending upon 
the temperature of the child, whose rectal tem- 
perature should at first be taken frequently. 
If there is a tendency for his temperature to 
be greatly reduced — below 95 F. — more ex- 
ternal heat will be necessary than if the tem- 
perature were 97 or 98 F. The best device 



216 Premature and Weak Infants 

among those which I have had an opportunity 
to observe for maintaining artificial heat is the 
electrotherm advocated and described by Holt, 
Diseases of Infancy and Childhood, 1906. 

"These small heaters are attached to an 
electric fixture, like a drop-light. A convenient 
size is from ten to fifteen inches. It is placed 
between two or three thicknesses of blankets, 
upon which the infant lies in its basket or crib. 
The degree of heat can be regulated according 
to the amount of electricity turned on. This 
mode of handling premature infants has been 
given thorough trial at the Babies' Hospital 
and has been found to fulfil the indication, 
with children as small as three pounds and as 
young as seven months, quite as well as the in- 
cubator, while at the same time being free from 
its dangers. It has not been necessary to raise 
the general temperature of the room. These 
patients when kept in the wards at an ordinary 
temperature have maintained an even bodily 
temperature much more uniformly than with 
any other method I have seen, the incubator 
included." 

A mistake often made in the management 
of premature and delicate infants is that of 
providing too warm air for respiration, a glar- 



Premature and Weak Infants 217 

ing defect in most incubators. The best means 
of decreasing a delicate child's vitality and re- 
sistance and increasing his chances of pulmon- 
ary infection, is to supply him constantly with 
air at 8o° to 90 F. In a modern house the 
maintenance of this temperature usually means 
an absence of change of air and an abundance 
of bacteria. The patients do best when the tem- 
perature of the air they breathe is from 70 
to 72 F. 

Necessity of breast-milk. — Breast-milk for 
premature infants born under twenty-eight 
weeks is almost a necessity, and should always 
be procured when possible for all premature 
children. The mother, with the rarest excep- 
tion, is unable to supply it, so that a wet-nurse 
should be secured. In selecting a wet-nurse 
for a premature baby it is advisable to take 
the wet-nurse's baby also, as the premature 
infant may not be able to nurse, or if he nurses 
he will not take all the milk. Pumping the 
breasts of a wet-nurse will almost invariably 
dry them up, if her own baby is not with her 
to furnish the necessary stimulation of nurs- 
ing. Sufficient milk may be removed by the 
breast-pump to supply the premature infant if 
he is unable to nurse, and the wet-nurse's baby 



218 Premature and Weak Infants 



will empty the breast. For premature babies 
who refuse the breast or are unable to take a 
nipple, the Breck feeder (Fig. 
13) may be used as a means of 
giving nourishment, or gavage, 
forced feeding with a tube, may 
be brought into use. This I have 
been obliged to resort to in sev- 
eral cases. The Breck feeder 
consists of a graduated glass 
tube, narrowed at one end. Over 
this end is placed a small rubber 
nipple, the other end being closed 
by a flexible rubber cap. Draw- 
ing on the nipple is aided and en- 
couraged by pressure on the air- 
filled cap. If the breast-milk 
proves too strong it may be 
diluted with equal parts of a 6 
per cent, sugar solution, one 
ounce of the mixture being given 
at first at intervals of two hours. 
Ten to twelve feedings may be 
given in the twenty-four hours, 
the amount depending upon the child's diges- 
tive ability. 

Feeding other than the breast. — If human 



FIG. 13. THE 
BRECK FEEDER 



Glands 219 

milk is not obtainable, whey made from whole 
milk may be given, or one ounce of gravity 
cream may be given with one ounce of milk- 
sugar, one ounce of lime-water, and fourteen 
ounces of water. Canned condensed milk, one 
part, to from 24 to 30 parts of water, may 
be used with advantage as a temporary feed- 
ing measure when nothing better is available. 
The food strength is increased, the intervals 
made longer, and the feeding larger, as the 
patient proves able to assimilate the food. 

GLANDS 

ACUTE ENLARGEMENT OF THE GLANDS OF 
THE NECK 

A mother is often alarmed by the sudden 
appearance of a hard swelling in the neck of 
one of her children. The swelling may appear 
during the night and increase greatly in size 
for a day or two, when it may be as large as 
a horse-chestnut. Such a condition is due to 
swollen lymphatic glands, which are usually 
situated just behind the jaw and below the 
ear. Occasionally the swellings may appear 
in the soft parts under the jaw. The glands, 
in the performance of their functions, have 
become infected and the swelling follows. The 



220 Glands 

cause of the infection will usually be found in 
a lesion of the mouth or throat. It may some- 
times be traced to a lesion of the skin in the 
neighborhood of the swelling-. Thus, the 
source of infection may be a decayed tooth, a 
simple abrasion of the mucous membrane, or 
an acute inflammation of the part, such as ton- 
sillitis or pharyngitis. In scarlet fever and in 
diphtheria the glands are often seriously in- 
volved. The glandular enlargements, how- 
ever, which appear suddenly, independent of 
serious illness, need cause no great anxiety. 
They terminate usually in one of two ways : 
they gradually disappear under treatment, or 
they break down and form an abscess which 
requires incision and drainage. In either event 
complete recovery follows. 

If the swellings occur in diphtheria or in 
any other infectious disease, they may con- 
stitute a grave complication. With their first 
appearance, apply cold compresses to the parts 
constantly until the physician arrives. 

CHRONIC ENLARGEMENT OF THE GLANDS 
OF THE NECK 

The lymphatic glands of the neck may be 
chronically enlarged as a result of tubercu- 



The Skin in Health 221 

losis, syphilis, or local infections from the 
skin, and a lowered general vitality. 

The mother usually notices a slight swelling 
of the parts, which, upon touch, gives the im- 
pression of a hard round body immediately 
beneath the skin; usually several of these 
nodules will be discovered. They often extend 
in chains down the side of the neck; some- 
times both sides will be involved. Bunches of 
glands may also appear under the ear and at 
the angle of the jaw. They vary in size from 
a buckshot to a butternut. 

Children with a tendency to enlargement of 
these glands should be constantly under medi- 
cal supervision. 

THE SKIN IN HEALTH 

The skin of an infant is extremely delicate 
and great care is required to keep it in a 
healthy condition. The secret of a healthy 
skin in an infant is in proper attention. It 
must be kept clean and dry. After the daily 
bath, in which no ingredient other than plain 
boiled water and Castile soap should enter, the 
baby must be carefully dried and the folds of 
the skin and flexures of the joints thoroughly 



222 Eczema 

powdered with equal parts of oxide of zinc 
and powdered starch. When the napkins are 
soiled they should be changed at once and the 
parts again washed and powdered. An occa- 
sional sponging, followed by a generous use of 
powder during very hot weather, will often 
prevent annoying skin affections, such as 
prickly heat and eczema. 

ECZEMA 

Eczema, a catarrhal inflammation of the 
skin, is a disease to which young children are 
very susceptible. It appears in different forms, 
which means that there are several varieties 
of the disease. Any portion of the skin sur- 
face may be involved. The parts most 
frequently affected are the scalp, cheeks, fore- 
head, and the flexures of the joints, where the 
skin surfaces come in contact. The cause of 
eczema may be from within or without. The 
external causes are all of the nature of irritants. 
A baby's skin is very delicate, and trifling 
causes will often produce a great deal of in- 
flammation. Strong soaps, liniments, a sudden 
exposure of the moist skin to cold air, exces- 
sive perspiration, insufficient bathing, dis- 
charge from the ear or nose, all may cause a 



Eczema 223 

local irritation and produce the disease. Al- 
lowing a child to rest in a soiled napkin is a 
most frequent cause of eczema of the buttocks, 
a condition which is elsewhere referred to. 
The treatment of this type of the disease re- 
solves itself into removing the cause and pro- 
tecting the parts by means of a suitable oint- 
ment or powder. 

Internal causes. — Among the internal causes 
indigestion is by far the most frequent. It is not 
the delicate child who suffers most from 
eczema. In many instances the robust nurs- 
ling and the vigorous bottle-fed baby are the 
sufferers. The child in other respects appears 
well, has a good appetite, is bright and happy, 
and shows normal development. The bright 
red and sometimes weeping area on each cheek, 
and the itching, scaly forehead, show clearly 
that something is wrong, and the error will 
be found in the gastro-intestinal tract. The 
food in some respect is unsuitable, not being 
properly adapted to the child's digestive 
capacity. 

Management in the breast-fed. — In the 
breast-fed, regulation of the life of the mother 
as regards her diet, exercise, and bowel func- 
tions will often effect a cure. 



224 Eczema 

The bottle-fed. — In the bottle-fed, an ad- 
justment of the food to the child's age and 
digestive capacity and attention to the daily 
bowel evacuation aids materially in the treat- 
ment. Constipation, if present, must be re- 
lieved. Local treatment with ointments, 
washes, and powders are all of little value if 
the cause of the disorder is not removed. The 
case may improve temporarily under the local 
treatment, but within a few days the inflamma- 
tion reappears in full force. 

Influence of fat and sugar. — An excess of 
sugar and fat in the diet or an incapacity for 
the substances are very frequent causes of 
eczema in bottle-fed children. 

Eggs and other albumins, both animal and 
vegetable, may cause eczema in susceptible 
subjects. 

The strait-jacket. — One of the difficult fea- 
tures of treating children with eczema is the 
tendency for the child to scratch the involved 
parts. This not only keeps up the trouble in- 
definitely but the nails are often the carriers of 
infection. I have seen not only severe derma- 
titis, but furunculosis and cellulitis develop in 
this way. One of the best means of preventing 
scratching is in the modified strait-jacket (see 



Eczema 



225 



Fig. 14). The jacket is made of muslin and 
must be fitted to the patient. The child is 




FIG. 14. STRAIT-JACKET 



slipped into the jacket feet first. The opening 
A encircles the thorax directly under the arms. 
The opening B is closed about the neck with 




FIG. 15. STRAIT-JACKET IN POSITION 

the attached tapes. The cord which is used 
to close the end of the sleeves may be tied 



226 



Eczema 



to the sides of the crib or pinned to the bed- 
ding. Children readily accustomed themselves 
to the position of lying on the back which its 
use necessitates. It is no kindness to allow 
a child to further irritate the already badly 
involved surfaces. 




FIG. l6. MASK PATTERN 



The mask. — In facial eczema, the itching is 
often most intense. In order to effect a cure, 
scratching and rubbing of the parts on any 
object with which the child may come in con- 
tact, must be prevented. The Thomas mask 
(see Fig. 16) answers this purpose admirably. 
The ointment or lotion is placed on clean linen 



Eczema 



227 



which rests on the involved parts. Over this 
is placed the mask. In Fig. 16 is represented 
a pattern of the mask. Opening A is suffi- 




FIG. 17. MASK IN POSITION 



ciently large to furnish space for the eyes, nose, 
and mouth. An elastic band which will be seen 
to pass over the upper lip, draws the sides of 
the opening together, insuring protection to 
the cheeks, usually the parts chiefly involved. 
B and C pass over the top of the head and are 
sewed to D and E which pass over the ears, to 



228 Hives 

the back of the head where they are united. 
The masks are best made of muslin or thin old 
linen, and are to be renewed daily. In using 
an ointment under the mask it is important 
that it be spread on old linen, and applied to 
the parts, and then the mask placed in position 
holds the dressing in place. 

HIVES 

The type of hives most frequently seen in 
children appears in the form of large wheals 
from one-half to one inch in diameter. There 
may be but two or three of these wheals, or 
a large portion of the body may be covered by 
them. They consist of a firm, flat, circum- 
scribed, reddened eruption of the skin, with- 
out any definite arrangement. In addition to 
the skin, the mucous membrane of the tongue, 
mouth, and pharynx may be involved. In 
some instances the eruption appears very sud- 
denly, lasts but a few hours, and quickly dis- 
appears. If the attack is of a severe nature 
new spots appear from time to time which be- 
have in the same way. Hives in children are 
due to digestive disorders. I have repeatedly 
known attacks to follow some unsuitable arti- 



Milk-Crust 229 

cle of diet, such as cakes, strawberries, pastry, 
or nuts. Constipation may cause an attack or 
they may be a reaction against a drug or some 
food protein. 

The only symptom of consequence is the 
distressing itching which is always present. 

Management. — Treatment consists in the 
use of laxatives and a temporarily restricted 
diet. The itching is best relieved by bathing 
the parts with a solution of carbolic acid — one 
teaspoonful to a pint of water. 

MILK-CRUST 

What is commonly known as milk-crust 
consists of the formation on the scalp of a 
thick layer of yellow sebaceous material. 
In addition to being unsightly it is very an- 
noying to the patient on account of the itching 
which it causes. The mother usually assures 
us that the condition is not due to neglect. The 
head is washed and oiled very often; but wash- 
ing will neither cure nor prevent the disease. 

Milk-crust is due to an inflammation of the 
sebaceous glands of the skin. 

Management. — The affection is easily le- 
lieved. The hair must be cut very short, and 



230 Intertrigo 

an ointment, composed of resorcin, twenty- 
grains, and vaseline, two ounces, should be 
spread generously over the diseased area and 
covered with a piece of linen which has been 
saturated with the ointment. Over this a fairly 
tight-fitting, home-made muslin cap should be 
worn to hold the dressing in place. The oint- 
ment should be applied twice daily. After 
three or four days of the treatment, during 
which time no water must touch the scalp, it 
may be gently cleansed with Castile soap and 
warm water, or with warm sweet oil. 

The whole or the greater portion of the 
crusts may be removed with the first washing. 
Some severe cases may require two or three 
repetitions of the treatment. After the scalp 
is clean, an application of the ointment at bed- 
time once or twice a week will prevent a re- 
turn of the trouble. 

INTERTRIGO 

Inflammation of the skin of the thighs and 
buttocks, by some mothers erroneously called 
sprue, is often seen in quite young children. 
If the child is allowed to lie in soiled napkins, 
the irritant discharges thus remaining in con- 



Intertrigo 231 

tact with the delicate skin, and inflammation 
and excoriation of the parts naturally follow. 
Children have delicate skins and often pass very 
acid urine. When this combination is present 
an inflammatory condition of the parts is fre- 
quently difficult to avoid. 

Management. — The management is simple, 
usually requiring only a changing of the nap- 
kin as soon as soiled and the generous use of 
zinc ointment. I have had very little success 
with dusting powders in such cases, especially 
in those of any degree of severity. After pas- 
sage either from the bladder or bowels, the 
napkin should be immediately removed, the 
parts gently washed with Castile soap and 
boiled water, or, in some cases, warm sterilized 
sweet oil may be used to better advantage. 
After the parts are clean, apply to the inflamed 
area pieces of clean old linen which have been 
covered with zinc ointment. If the ointment 
is applied directly to the skin the napkin soon 
absorbs it, and its application will be of no 
service. The ointment acts as a barrier be- 
tween the irritating passages and the inflamed 
skin. The beneficial effects of the zinc oint- 
ment will be appreciably increased if white 
wax (10%) is added to it. Under this treat- 



232 Prickly Heat 

ment I have repeatedly seen the worst cases of 
intertrigo recover in a week. 

Of course the applications must be repeated 
after each cleansing and drying. The oint- 
ment must be used extravagantly. The dress- 
ing is then applied to the parts and is to be 
changed several times daily. The urine which 
is chiefly at fault, is prevented by the ointment 
dressings from coming in contact with the 
skin, the treatment being solely protective. At 
the same time a quantity of absorbent cotton 
is placed next to the genitals so as to absorb 
the urine as it is passed and thus prevent its 
general distribution over the parts. When the 
case is well advanced toward recovery, scrupu- 
lous cleanliness and a dusting-powder com- 
posed of equal parts of powdered starch and 
oxide of zinc will usually be all that is required. 
In all children or when there is an inflamed 
condition of the groins and buttocks it is ad- 
visable to put on the napkins in rectangular 
form as described on page 4. 

PRICKLY HEAT 

In prickly heat there is an acute engorge- 
ment of the vessels of the sweat-glands with 



Prickly Heat 233 

obstruction to their outlet. Minute papules 
form which are reddish in color. The mild 
cases are without inflammation. When in- 
flammation develops, small vesicles also ap- 
pear and may cover large areas of the body. 
Nearly every infant suffers from prickly heat 
in summer. It is most frequently seen on 
the head and neck and over the chest and 
shoulders. The patients are very uncomfort- 
able and restless. There is evidently a great 
deal of burning and itching. The condition 
is caused by heat, due either to too much 
clothing or to the hot weather of summer; 
both causes may be operative. I have fre- 
quently seen it in winter in overclad children. 
Most babies are overclad at all seasons of the 
year. When prickly heat develops, regardless 
of the season, it is a sure sign that the child 
has been kept too warm. The duration is de- 
pendent upon climatic conditions and also upon 
the treatment. 

Management. — Heavy clothing and flannels 
are to be avoided. The clothing should be 
light in weight and of loose texture. In order 
to lessen the local irritation the garment worn 
next to the skin may be lined with silk, linen, 
or gauze. The further means of management 



234 Prickly Heat 

as regards both the relief afforded the patient 
and the cure of the condition, consists in the 
frequent application of cool water, in the form 
of either a tub-bath or sponging. The soda 
bath, the bran bath, and the starch bath (page 
116) are all most useful. For purposes of 
sponging, a solution of bicarbonate of soda 
should be used — one tablespoonful to a gallon 
of water. The relief afforded the patient de- 
pends not so much upon what is used in the 
water as upon the fact that plenty of cool water 
comes in contact with the itching, burning 
skin. Ointments and salves are of little service 
here, as they tend to produce further macera- 
tion of the skin. As local applications, powders 
are preferred to lotions. A powder used with 
satisfaction in this condition is of the follow- 
ing composition : 

I£ Boracic acid, 60 grains. 

Powdered starch, , 

each 1 ounce. 
Powdered oxide of zinc, 



This is to be dusted freely over the involved 
surface several times daily, every hour if neces- 
sary. 



Fissures of the Anus 235 

FISSURES OF THE ANUS 

In children suffering from what are called 
fissures of the anus there will be found one 
or more slight tears in the mucous membrane 
just inside the anal aperture. In such cases 
there is always a history of an intestinal dis- 
order, usually constipation, sometimes diar- 
rhoea, the fissures having been caused 
either by a stretching of the parts by a hard, 
constipated movement, or by the frequent irri- 
tant passages which have caused a destruction 
of the mucous membrane of the parts. 

An infant thus affected cries lustily when 
having a passage, and strains and presses for 
some time afterward. Very often the passage 
will be streaked with blood. Older children 
postpone going to stool as long as possible and 
complain greatly of pain when the bowels 
move. 

Management. — These cases will be greatly 
relieved by the correction of the intestinal 
derangement. If the child is constipated, the 
movements should be kept soft by the use of 
suitable diet and laxatives. (See page 265.) If 
there is diarrhoea, suitable diet and medical 
attention are necessary. The local treatment, 



236 Boils 

which may be necessary, should be carried out 
by a physician. 

BOILS 

Infants are particularly subject to boils, 
which are supposed by many to indicate some 
radical blood disorder. As a result, the victims 
are drugged and purged with all sorts of teas 
and "blood-purifiers." The cause of the boil 
is very rarely from within. It is usually the 
result of a local infection or inoculation into 
the skin, the germs finding entrance by means 
of a hair follicle or an abrasion so small as to 
be invisible to the naked eye. A boil having 
formed, the pus is carried to other portions of 
the skin by the lymphatics, or it escapes upon 
the surface, and, in either case, other portions 
of the skin are inoculated, and a series of boils 
results. The parts most often involved are the 
head, the neck, and the shoulders, although 
they may appear upon any portion of the body, 
with the exception of the palms of the hands 
and the soles of the feet. I have opened one 
hundred and four on one child during a period 
of three weeks. While boils are more fre- 
quently met with among the debilitated and 



Head Lice— Pediculi Capitis 237 

weakly, they are by no means uncommon in the 
strong and otherwise well. 

Management. — Poulticing, and allowing a 
boil to open spontaneously, is calculated to pro- 
long the trouble indefinitely. A boil should 
be opened early, the pus evacuated, and the 
surrounding skin thoroughly washed with soap 
and water, when an antiseptic dressing com- 
posed of several thicknesses of old linen, which 
has been boiled and dried and then dipped into 
a saturated solution of boracic acid, answers 
every purpose. Not only the boil but the ad- 
jacent skin for several inches must be covered 
by the dressing, which is to be kept wet with 
the boracic acid solution. 

HEAD LICE— PEDICULI CAPITIS 

Head lice, or pediculi capitis, are very fre- 
quently seen in out-patient and hospital work 
among children in all the larger cities. Occa- 
sionally other children become infected in 
school or in public conveyances and carry the 
vermin to other members of the family. 

Management. — The most successful and 
cleanly treatment consists in cutting the hair 
short; this done, wash the head with soap and 



238 Fever 

water once a day, and after drying moisten 
the scalp thoroughly with the following solu- 
tion twice daily: 

Acetic acid 2 drachms. 

Sulphuric ether 3 ounces. 

Tincture of larkspur, 



, of each 4 ounces, 
bpintus vim rect., 

Improvement will follow a few treatments. 
The pediculi will be killed and the nits may 
be removed with a fine-tooth comb. If the 
patient is a girl, it is not absolutely necessary 
to sacrifice the hair. It may be parted from 
various portions of the scalp and the solution 
applied without previous washing. However, 
if the hair is not cut, a much longer time will 
be required to effect a cure. 

FEVER 

By fever we understand an elevation of the 
temperature of the body above the normal, 
which in an infant is 99 F. by rectum. Fever, 
however, does not constitute disease. It is 
nothing more or less than a symptom, but it 
always means that something is wrong with 
the baby. It may be due to a slight attack of 



Fever 239 

indigestion, the eruption of teeth, or to the 
beginning of scarlet fever, diphtheria, or some 
other disease. Children develop fever much 
more readily than adults, and it is of less signif- 
icance in them. A child with fever that is 
appreciable to the touch of the mother will 
usually register a temperature of ioo.5°-ioi.5° 
F. While such a temperature is by no means 
alarming, its cause should be discovered. In 
the absence of a clinical thermometer, in order 
to examine a baby for fever, place upon the 
abdomen the palm of a hand which has been 
previously warmed. Examination of a child's 
hands, head, and feet furnishes us very in- 
exact means of judging as to the question of 
fever. Many times these parts will be cold 
when the thermometer registers a temperature 
of 104 or 105 F. Every young mother 
should possess, and know how to use, a clinical 
thermometer. 

Management. — In case of sudden high 
fever — 104 to 105 F. — from any cause, the 
mother cannot make a mistake in giving an 
alcohol and water sponge-bath at a tempera- 
ture of 85 F. One part of alcohol may be 
added to 3 parts of water and the child sponged 
for twenty minutes. If necessary the sponging 



2\o Malaria 

may be repeated every two or three hours ; this 
will keep the child comfortable until the arrival 
of the physician and perhaps prevent unpleas- 
ant complications. In case of fever the nour- 
ishment should always be reduced at once; if 
the child is on the bottle, reduce the strength 
of the food one-half by the addition of boiled 
water. If the child is nursed, reduce the dura- 
tion of each nursing period one-third. Chil- 
dren with fever can always have plenty of cool 
boiled water to drink. Mothers must remem- 
ber that it is not the fever per se, but the con- 
dition of the patient, which governs us in our 
treatment. In scarlet fever and pneumonia, a 
temperature of 102 to 104 F. is expected, and 
need cause no alarm. 

MALARIA 

Children in New York City and vicinity 
occasionally suffer from malarial fever. Fewer 
cases come under my observation now than 
formerly. Malaria is caused by a germ, the 
Plasmodium malarice. 

The disease is transmitted by means of a 
mosquito. The mosquito bites an individual 
who has malaria. The mosquito becomes in- 
fected and infects the next person bitten. 



Tuberculosis 241 

The fever, languor, and drowsiness will ap- 
pear at a definite time each day, — usually from 
three to five o'clock in the afternoon. The 
child wakes the following morning apparently 
well, but at about the same hour in the after- 
noon the symptoms are repeated. There is 
always a distinct periodicity in the symptoms. 
In some cases the child will be ill every second 
day, but at the same hour. In other cases the 
symptoms are still more characteristic and are 
easily recognized. At a certain time every 
day, or perhaps every second or third day, 
there will be a chill and a rapid rise in tempera- 
ture, followed by a profuse perspiration, dur- 
ing which the fever subsides. 

Management. — The treatment of malaria 
in children is by the use of quinine. The ma- 
jority of the cases recover satisfactorily under 
quinine, but it should never be given without 
a physician's order. 

TUBERCULOSIS 

Tuberculosis is an infectious disease which 
carries off one-seventh of the population of 
the earth. Children are very susceptible to the 
infection. The disease is caused by the en- 
trance into the system of a micro-organism 
16 



242 Tuberculosis 

known as the tubercle bacillus. Tuberculosis is 
not inherited. The disease always comes from 
without, as does typhoid fever or diphtheria. 
We often see parents and children in turn 
sicken and die with this disease. This does 
not necessarily mean heredity, however. It 
means that there is a family condition of con- 
stitution which furnishes a favorable soil for 
the development of the bacillus. If all who swal- 
lowed or inhaled the tubercle bacillus became 
tubercular, the earth would be depopulated in 
a very few years. We have all taken the 
tubercle bacillus into our bodies at some time, 
probably many times. In one individual the 
germ finds a favorable soil and flourishes; 
in another, unfavorable conditions — health and 
vigor of constitution, — and it dies. The usual 
means of infection is through the inspired air 
by the inhalation of the infected dust from the 
public conveyances, from the street, or from 
infected dwellings, or in association with peo- 
ple who have tuberculosis. Children being very 
susceptible, should never associate with tuber- 
cular adults. Infection may also take place 
by direct contact through kissing. The bacillus 
may be swallowed with food or drink which 
has been contaminated. 



Tuberculosis 243 

Parts of the body involved. — Almost every 
portion of the body may become the seat of 
the tubercular process. When the micro- 
organism attacks the lungs, it produces what 
is known as consumption, or pulmonary tuber- 
culosis. When the covering of the brain is 
involved, the child has tubercular meningitis. 
When the hip-joint is attacked, hip-disease fol- 
lows. When the spine is attacked, it produces 
what is known as Pott's disease. When the 
glands of the neck are infected, scrofulous 
glands or tubercular adenitis is the outcome. 
Tubercular disease of the knee is commonly 
known as white swelling. These are the parts 
which are most frequently the seat of the 
tubercular process. With less frequency the 
bacillus attacks the bladder, the kidneys, the 
skin, the intestines, the mesenteric glands, and 
the peritoneum. 

General tuberculosis. — In institutions and 
among the poor, what is known as general 
tuberculosis causes the death of many infants. 
At autopsy they show an involvement of nearly 
all the internal organs. Tuberculosis in chil- 
dren is always a very serious disease, but it is 
not necessarily fatal; many cases recover. 
When the disease involves the spine, hip-joint, 



244 Rickets 

or knee-joint, or the glands of the neck, the 
prognosis as regards life is usually good. When 
the brain. is attacked, it is always fatal. In 
tubercular disease of the lungs in very young 
children the prognosis is very grave. Many 
older children — those from seven to twelve 
years of age — recover if the disease has not 
progressed too far before coming under treat- 
ment. 

Management. — The important features in 
the management of these cases are : competent 
medical care, change to a dry climate at an ele- 
vation of one thousand to fifteen hundred feet, 
with close attention to hygiene and a carefully 
regulated diet in which there should be a gener- 
ous allowance of meat, eggs, and milk. 

RICKETS 

Rickets is a constitutional disease due to 
malnutrition. The lack of suitable nourish- 
ment manifests itself in characteristic changes 
in the bones, muscles, and in the nervous sys- 
tem. In addition to their physical characteris- 
tics, children with this disease may show de- 
layed mental development. A rachitic child 
is usually under weight and undersized, par- 



Rickets 245 

ticularly as regards length. The head is ill- 
shaped, the enlargement of certain bones of the 
skull giving the head a square appearance. The 
sutures and fontanelle close very late. I have 
seen the fontanelle still open at the fourth year. 
The teeth are cut late, are apt to be soft, and 
decay early. Many rachitic children do not 
get the first teeth until after the twelfth month 
is passed. The chest is narrow and depressed 
at the sides, and along its anterior portion, at 
the junction of the costal cartilages with the 
ribs, a row of nodules can be traced. The ends 
of the long bones, particularly at the wrists 
and ankles, are very much enlarged. In many 
cases this enlargement is so great that it pro- 
duces quite a deformity. Often the legs are 
curved, a condition known as "bow-legs." The 
spine is weak and in severe cases the child is 
unable to sit erect. Spinal curvature is fre- 
quently seen in these children. The abdomen 
is usually very prominent. The malnutrition 
is further shown by the flabby, poorly devel- 
oped muscles, by the tendency to perspiration, 
particularly about the head, and by the unstable 
nervous system. These children are restless, 
irritable, and hard to please, and have convul- 
sions under slight provocation. Not all rachi- 



246 Scurvy 

tic children are below weight; some are quite 
fat, but pale and flabby. The changes in the 
bones, however, are similar in both types. In 
addition to the characteristics noted, rachitic 
children possess feeble powers of resistance. 
They are prone to catarrhal affections of the 
respiratory and intestinal tracts. In many in- 
stances, they teeth late and with much diffi- 
culty. On account of their enfeebled condition 
and lack of resistance, illness in a rachitic child 
is apt to be tedious, if not serious. 

The prevention of rickets depends upon 
proper feeding. Condensed milk used unad- 
visedly and the proprietary meal foods are re- 
sponsible for many cases. 

Management. — Proper management requires 
suitable food, cleanliness, fresh air, and cod- 
liver oil. By "suitable food" is meant good 
milk for children under one year, to which 
meat, eggs and vegetables are added as soon 
as they can be digested — usually after the 
eighth month. 

SCURVY 

Scurvy is a disease of quite frequent occur- 
rence among bottle-fed children. It is charac- 



Scurvy 247 

terized by pain in one or more of the joints of 
the long bones, with or without swelling of 
the involved parts and discolored, spongy, or 
bleeding gums. Hemorrhages into the skin 
sometimes occur, which give the child a pecul- 
iar mottled appearance. The disease is often 
mistaken for rheumatism because of the 
swollen and painful joints. If the case is a 
very severe one it may resemble paralysis in 
some of its aspects. 

The disease is due to errors in nutrition. 
The great majority of the cases develop in 
those who are being fed on proprietary meal 
foods, condensed milk, and overcooked cows' 
milk. 

Among the author's cases, one symptom 
was always present : they all showed evidences 
of faulty nutrition; they also presented another 
symptom in common which was the earliest 
active manifestation of the disease, and that 
was pain. The child that has been playful, 
active, and has enjoyed attention, suddenly 
undergoes a change — he prefers to rest in the 
crib or carriage, cries when handled, and re- 
fuses to play. Often the first signs of trouble 
will be noticed when changing the napkin or 
putting on the shoes or stockings. The move- 



248 Scurvy 

ment of the diseased parts causes pain and 
the child cries lustily. If he is undressed and 
rests on his back, the affected limb in all proba- 
bility will remain motionless, while its com- 
panion may be moved freely. 

The symptom of pain appears before the 
swelling of the joints, which is sure to follow 
in case the disease is not recognized early and 
treated properly. Another characteristic symp- 
tom is the swollen, congested, and bleeding 
gums about the upper incisor teeth. This con- 
dition is sometimes seen early in the attack, 
but it is usually a later symptom. Hemor- 
rhages into the skin are of comparatively in- 
frequent occurrence. 

Scurvy uncomplicated is not accompanied 
by fever. Acute articular rheumatism is always 
accompanied by fever. Rheumatism is rare 
in children under two years of age; scurvy is 
rare in children over two years of age. There 
is no excuse for an error in diagnosis between 
the two affections. 

Management. — The treatment is : fresh 
cows' milk, beef juice, and orange juice. For 
a child one year of age the juice of one orange 
should be given daily. Under proper treat- 
ment the average case will be well in a week or 



Rhuematism 249 

ten days, improvement being noticed in from 
twenty-four to forty-eight hours after begin- 
ning the treatment. 

RHEUMATISM 

Rheumatism is a disease of very grave im- 
port and of rather frequent occurrence among 
children after the third year. Under the second 
year it is of the rarest occurrence. At this 
age scurvy is frequently diagnosed as rheuma- 
tism. It may appear in all degrees of severity. 
The mild attacks are often so slight that a 
physician is not consulted and the diagnosis of 
rheumatism never made. Such cases are often 
mistaken for sprains and so-called ' 'growing- 
pains." Aside from this mild type we have the 
disease in all degrees of severity. The severe 
articular form known as inflammatory rheu- 
matism, is that in which the child, with high 
fever, reddened, swollen joints, dreads your 
approach to the bedside and begs you not to 
touch him. 

The heart in rheumatism. — There can be no 
attack of rheumatism so mild that it should be 
ignored. Every child ill with this disease is 
in danger of heart complications which may 



250 Grippe 

make him an invalid for life. Probably nine- 
tenths of the cases of valvular heart disease in 
adults are due to attacks of rheumatism during 
childhood, and in many instances the disease 
of the heart is not recognized until long after 
the rheumatic attack. In every case of rheu- 
matism the heart should be examined and prop- 
erly treated. Heart involvement is as liable to 
develop in the mild as in the severe attacks. 
In some cases it is the only evidence of the 
presence of rheumatism. Children of rheu- 
matic parentages and those who show rheu- 
matic tendencies should be under the constant 
supervision of a physician. 

GRIPPE 

Grippe is a disease very prevalent among 
children during the colder months. It is due 
to a micro-organism which is usually taken 
into the system with the inspired air. There 
are four types of the disease to be seen in chil- 
dren. 

In the most common type the respiratory 
passages are the parts chiefly involved. The 
symptoms resemble in some respects those of 
a common cold. There is running at the nose, 



Grippe 251 

cough, sore throat, and, generally, bronchiits. 
There is a higher fever, however, than can be 
explained by the catarrhal symptoms, greater 
muscular weakness, and greater prostration. 
If uncomplicated, the disease usually runs its 
course in from five to eight days. The com- 
plications to be especially dreaded are bronchi- 
tis, pneumonia, and otitis. 

The next most frequent type of grippe is 
the muscular. There is fever, headache, loss 
of appetite, prostration, and great muscular 
weakness. There is little or no involvement 
of the respiratory tract. 

The third type includes the cases in which 
the intestinal symptoms predominate. The 
child is taken ill suddenly with fever, prostra- 
tion, and diarrhoea which is very hard to con- 
trol. There are from eight to sixteen green, 
watery passages daily, containing a moderate 
amount of mucus, streaked with blood. There 
is also slight cough and coryza, with consider- 
able congestion of the throat. 

In the fourth type the nervous system is 
chiefly affected. These patients have the fever 
and muscular soreness common to all varieties, 
with the prominent symptom — excessive irri- 
tability. In some cases there seems to be al- 



252 Grippe 

most entire loss of self-control. The patients 
are peevish, fretful, depressed and hysterical 
by turn. They cannot bear the slightest 
noise, and sleep only when under the influence 
of drugs. 

The severe cases, however, have two symp- 
toms common to all — fever and intense pros- 
tration; prostration and weakness out of 
proportion to all objective symptoms are the 
peculiar characteristics of grippe. I have lost 
two patients aged, respectively, three and four 
months, in both of which the system was com- 
pletely overwhelmed by the virulence of the 
grippe poison. Both children died in less than 
twenty-four hours, apparently from exhaus- 
tion. Post-mortem examination failed to de- 
tect in either case any organic change sufficient 
to cause death. 

A very unpleasant feature of grippe is the 
wretched physical condition in which the 
patient is often left after the acute symptoms 
have disappeared. Weeks of the most careful 
treatment will frequently be required to re- 
store his previous good health. A feature in 
grippe is the tendency toward a slight rise of 
temperature ^2 to i° F. after the child is other- 
wise well. 



Convulsions 253 

Management. — There is no specific treat- 
ment for this disease. Every case must be 
treated according to the symptoms presented. 
For those which fail to make prompt recovery 
a change of climate should be advised. Many 
of my patients have done surprisingly well at 
Lakewood, or at Atlantic City. 

CONVULSIONS 

A convulsion is a temporary loss of con- 
sciousness, associated with rhythmical con- 
tractions of various muscles of the body. 
Rachitic, delicate children, and those suffering 
from malnutrition in any form are predis- 
posed to convulsions. Disturbances in the 
gastro-intestinal tract, due to errors in feed- 
ing, have been the cause in ninety-five per cent, 
of my cases. Nearly all were seen among the 
badly bottle-fed or in those beyond the bottle 
age who had been given food unsuited to their 
years. I have frequently known seizures to 
follow an unusual indulgence in cake, pie, or 
fruit. Excessively high fever may be a cause 
of convulsions. Pneumonia, meningitis, and 
contagious diseases are sometimes ushered in 
by convulsions. Heat prostration and worms 



254 Convulsions 

may be mentioned as infrequent causes. A 
patient — a boy three years old — had repeated 
convulsions until he was relieved of forty-three 
large round worms. According to my obser- 
vation, dentition is rarely an immediate cause. 
The dentition period covers eighteen months, 
and children often have convulsions during 
this time; a thorough examination of the pa- 
tient, however, will usually reveal the seat of 
the trouble in the intestinal canal or stomach. 
Dentition may indirectly be a factor. A few 
years ago a mother insisted that I should lance 
the healthy gums of a girl eighteen months of 
age, who repeatedly had convulsions. This I 
refused to do, and ordered, instead, two tea- 
spoonfuls of castor-oil. The child passed one- 
quarter of a partially masticated orange and 
the convulsions ceased. 

Management. — When a child is attacked, 
prompt action is necessary. The family phy- 
sician should be sent for and the patient placed 
at once in a mustard bath at a temperature of 
105 F. ; an even tablespoonful of mustard 
should be added to five gallons of water. The 
patient should not be allowed to remain in the 
bath over ten minutes, when he should be re- 
moved and dried vigorously. If possible, the 



Convulsions 255 

child's temperature should be taken while in 
the bath, and if above 102 F. (in convulsions 
it usually ranges between 104 and io6°F.) 
the temperature of the water should be lowered 
to 75 or 8o° F. by the addition of ice or cold 
water. Watch the effect of the cooling of the 
bath upon the child's temperature, and when it 
is reduced to ioi°F. remove him. The tem- 
perature in convulsions should always be noted. 
To my mind the high fever has oftentimes a 
great deal to do with the seizure. Not long 
since I was called to see a child in convulsions. 
Upon my arrival I learned that he had been 
put into a hot bath at no F., and kept there 
fifteen minutes, but the child showed no signs 
of improvement. The temperature was taken 
while in the bath, and registered iii°F., as 
high as the thermometer would register. In 
this case the hot bath was the worst means of 
treatment that could be devised. There is no 
advantage in making the water hotter than 105 
F. In the bath, or immediately upon removal, 
give an enema of soap and water so as to in- 
sure a movement of the bowels as soon as possi- 
ble. As soon as the child can swallow, one or 
two teaspoonfuls of castor-oil should be given. 
If it is known that the child has taken some- 



256 Colic 

thing indigestible, a teaspoonful of syrup of 
ipecac should be given, and repeated in twenty 
minutes if vomiting does not follow. The con- 
vulsion is very apt to be repeated if the cause 
is not removed. The patient should not be held 
on the lap. He should be placed in his crib 
and kept very quiet. Cold cloths should be 
applied to the head and a hot-water bag to the 
feet. No solid food or milk should be given 
for twenty- four hours; broths and barley- 
water should constitute the diet. During the 
next few days there should be no excitement, 
and the physician's orders regarding medica- 
tion and diet should be carefully carried out. 

COLIC 

There are few children who reach the age 
of one year without having suffered from 
colic. Infants in the earliest months of life 
are particularly susceptible to such attacks. 
The majority of cases are seen in children 
under five months of age, although the seiz- 
ures may continue until a much later period. 
During the attack the child cries violently, 
becomes red in the face, clinches its fists, draws 
up its legs, doubles up its body, and straightens 



Colic 257 

out again. The abdomen is hard, often dis- 
tended, and the hands and feet are cold. The 
child rests a few moments and cries again. 
Often all attempts at comforting him fail. 
An attack may continue for a few moments to 
an hour or more, perhaps until the child sleeps 
from exhaustion. I have had children brought 
to me for treatment who were so hoarse from 
crying that they could scarcely utter a sound. 
There may be several attacks a day after the 
feedings or they may not appear until evening. 
Afternoon or evening colic is probably most 
frequent. These cases are easily explained. The 
overtaxed stomach has done its work fairly 
well early in the day, but as the improper, fre- 
quent feedings follow, it becomes tired and 
refuses to work "overtime." During the night 
some rest is obtained, but the following day 
the entire programme is repeated. So-called 
colicky children are often otherwise perfectly 
well. If the trouble is not particularly severe, 
they may be well-nourished and well-behaved 
babies when not in pain. In the severe cases 
there is apt to be evidence of marked malnu- 
trition. It is often remarked that "a baby 
must do just so much crying," and nothing 
is done to relieve it. If one baby cries more 



258 Colic 

than another it is because he suffers more. A 
baby rarely cries unless he is uncomfortable 
or in pain. He may cry while his clothing is 
being changed because it disturbs him; he will 
cry from cold, hunger, from the effects of a 
misdirected pin, or from pain of any nature, 
but never without reason. The general ten- 
dency of the child is to play, to smile and be 
happy. When this is not the case something 
is wrong. 

Cause of colic. — Colic in every instance 
means indigestion. It means that, whether 
breast-fed or bottle-fed, the food. is not suit- 
able, — is not adapted to the child's digestive 
powers, or not properly given. The child who 
suffers from habitual colic is usually consti- 
pated. It has been my experience that the 
chief error in the diet causing the colic was 
the excess of the proteid — the curd-forming 
element in the milk. It is thus practically use- 
less to give carminatives and soothing syrups, 
and other remedies of a sedative nature, ex- 
cepting for the immediate effects. 

General management. — Whatever error may 
exist in the feeding must be corrected. If the 
patient is a breast-baby we must treat the 
mother — the source of the child's nourishment. 



Colic 259 

Nursing mothers of colicky babies are usually 
of sedentary habits, hearty eaters, and consti- 
pated. Our first step must be to cure the con- 
stipation of the mother. She should have one 
full, free passage from the bowels daily. She 
should exercise in moderation in the open air : a 
walk of an hour or two in the morning, and an 
hour in the afternoon, will be most beneficial. 
Her diet should consist of fresh meat, poultry, 
fish, cereals, soups, baked potato, green vege- 
tables, and stewed fruit. Coffee may be taken 
in moderation; milk, cocoa, chocolate, and 
water may be taken freely. A nursing mother 
should drink no tea. It is a popular idea that 
tea is a very necessary article for the nursing 
mother. Hardly a w r eek passes but I hear 
from the out-patient mother of a sick breast- 
baby that she is drinking from one to two gal- 
lons of tea a day. The tea is kept "on the back 
of the stove," so as to be ready for use at any 
time. I have relieved many cases of colic in 
the child simply by curing the mother's con- 
stipation and regulating her diet. 

Menstruation often causes temporary at- 
tacks of colic and other digestive disturbances 
in the child. Fright, anger, worry, or any- 
thing in the nature of a shock in the mother 



260 Colic 

will often seriously affect the child's digestion. 
In short, when the nursing child suffers thus 
from digestive derangements, the error, nine 
times out of ten, rests with the mother. The 
trouble is rarely with the child. 

As previously stated, habitual colic in the 
bottle-fed tells us that we are not giving the 
child a suitable food, or that we are not giving 
a suitable food properly. The food as a whole 
may be too strong or too weak. It may be 
given too frequently. If cows' milk is the diet, 
the error is often due to improper modification. 
The proteid will usually be found in excess, not 
in excess, perhaps, for the average child, but in 
excess for the patient in question. There can 
be no set rules for feeding or definite formulae 
for various ages that are infallible. The food 
of artificially fed children must be adapted to 
meet their individual requirements. The treat- 
ment of habitual colic in the bottle-fed consists 
in rendering the food suitable. 

Management of acute attacks. — For the re- 
lief of immediate attacks, an injection of from 
six to eight ounces of water at no°F., to 
which one-half teaspoonful of salt has been 
added, will often be of service. Five to eight 
drops of gin in a teaspoonful of warm water, 



Constipation 261 

by mouth, is sometimes useful. Two-drop 
doses of Hoffmann's Anodyne in two teaspoon- 
fuls of hot water will frequently cut short a 
severe attack. Both the gin and the anodyne 
may be repeated in one-half hour if relief is 
not obtained. If the attack is prolonged, a hot- 
water bag should be placed at the feet, and 
flannels wrung out of hot water applied to the 
abdomen. Oftentimes, in order that the diges- 
tive organs may have a complete rest, it is ad- 
visable to discontinue the regular food for a 
few hours and give barley-water as a substi- 
tute. 

CONSTIPATION 

Among the derangements of the young, 
there are few which give more annoyance or 
are harder to manage successfully than con- 
stipulation. The causes of the trouble are ana- 
tomical and dietetic. The comparatively long 
large intestine folded upon itself in the nar- 
row pelvis offers an obstruction to the free 
passage of the intestinal contents. The lack 
of development of the muscular structure of 
the intestine is also a cause. Deficient nerve 
power, due to lack of development of the sym- 



262 Constipation 

pathetic nervous system, is thought by many 
to be an important factor. In all probability 
all these agents may be regarded as predispos- 
ing causes of constipation. The chief cause of 
constipation, however, according to my obser- 
vation, is the proteid (the curd) in the child's 
milk. When the amount of proteid is exces- 
sive — a higher percentage than normal — the 
child is apt to be constipated. A child fed on 
a normal proteid with a low fat may also be- 
come constipated. 

Management in the breast-fed. — Among the 
breast-fed, the dietetic management of this 
disorder is difficult, for it is hard to change 
the character of the mother's milk. Much may 
be done, however. Inquiry into the daily life 
of the mother will usually disclose sedentary 
habits, a good appetite, a fondness for tea, 
and, probably, constipation. An examination 
of the milk of these mothers will show that 
the normal proportions of fat, proteid, and 
sugar are not maintained. The percentage of 
proteid is usually found to be higher than 
normal, with low or normal fat. 

The first step in the treatment is the regu- 
lation of the habits of the mother. The bowels 
should be evacuated daily, with a laxative, if 



Constipation 263 

necessary. She should be placed on a diet of 
fresh meat, fresh vegetables, and fruit. A 
malt liquor with luncheon or dinner is also 
sometimes recommended. She is instructed 
to take exercise daily in the open air. This 
regime will diminish the proteid and increase 
the fat in her milk, and not only relieve con- 
stipation in the child, but insure better nourish- 
ment and a later weaning than would otherwise 
be possible. The treatment of the mother is 
all that is necessary in a considerable num- 
ber of cases, but when this fails, the child de- 
mands attention. 

In treating the child my first step is to give 
cream ; not cream purchased as such, but cream 
which rises upon the best milk obtainable. I 
give from one-half to two teaspoonfuls in quite 
warm water immediately before nursing. The 
use of the gluten suppository at the same hour 
for several consecutive days will do much to 
establish the habit of a passage at a regular 
hour each day. 

In case the cream does not agree with the 
child or is ineffective, pure cod-liver oil — 
fifteen to thirty drops three or four times a 
day, or one teaspoonful of sweet oil two or 
three times a day — may prove beneficial. 



264 Constipation 

When these measures fail, as they will in a 
small number of cases, liquid albolene (aro- 
matic), so-called mineral oil, may be used, two 
to four teaspoonfuls daily. Whenever medi- 
cation is used it should be given immediately 
before the meals.. 

In all my breast-fed babies one bottle 
feeding daily is advised, in the constipated 
infant the feeding may consist of malted 
milk which is laxative to many infants. Five 
rounded teaspoonfuls are added to six ounces 
of hot water. 

Never allow a baby or young child 
to be put to bed for the night without an 
evacuation of the bowels having taken place, 
during the previous twenty-four hours. An 
enema of soap water four to eight ounces, or 
a gluten suppository should be used in such an 
emergency. 

Management of the bottle-fed. — In our 
treatment of infants a feature not to be lost 
sight of is that the principle business of the 
small individual is to grow normally — not only 
as regards weight and height, but he is re- 
quired to develop — good bone and muscle and 
nerve structure. 

In order for this to take place he must have 



Constipation 265 

food containing certain nutritious elements. 
We are thus limited in our dietetic manage- 
ment because considering only the constipated 
infant we might remove certain food elements 
necessary to the growth of the child. If a 
child is thriving on the bottle formula and all 
is well excepting the constipation, it is not 
wise to make too radical changes. The only 
change permissible rests with the sugar, and 
all sugars have practically the same nutritional 
value. Instead of using milk sugar in the 
formula, we would suggest a formula which 
has laxative variety, such as the sugar we have 
in Dextra Maltose No. Ill to be used in the 
same proportion as milk sugar or Mellin's 
Food which is a Dextra Maltose and may be 
employed in similar amounts. The milk given 
the bottle-fed constipated infant should not 
be cooked if the season of the year and the 
character of the milk allows. Neither lime 
water or barley should be used in the formula. 
Oatmeal may be substituted for barley and milk 
of magnesia one to three teaspoonfuls suffi- 
cient to act as a mild laxative may be used in 
place of lime water. 

Management in older children. — In " run- 
about" children the use of cream and water 



266 Constipation 

mixtures, rare meat, green vegetables, stewed 
and raw fruit, renders the management of 
constipation exceedingly simple. The meals 
must be given at regular intervals, and crackers 
and white bread excluded. The Bennett's 
wheatsworth biscuit and whole wheaten bread 
may be used with advantage. One tablespoon 
Kellogg's bran may be added to cereal once 
or twice a day. Fruits are best given between 
meals. The juice of two oranges may be given 
at 9 a.m., or four ounces of prune juice and 
apples, pears, grapes, or peaches at 4 p.m. 

It is our hope in treating constipation to 
relieve the patient by the dietetic measures 
above suggested. When these fail, we must 
resort to other means. Enemas and supposi- 
tories may be used occasionally, but the child 
should not become accustomed to them. In 
the severe cases which resist dietetic treatment, 
the outlook for an early recovery is not promis- 
ing. In such cases the use of an enema of 
olive oil at bedtime has proven very satisfac- 
tory. A small amount of the oil, two to three 
ounces, is introduced through a large catheter, 
No. 18 American (male), which is inserted 
ten or twelve inches, the catheter being at- 
tached to a bulb syringe with a capacity of 



Constipation 267' 

six ounces (see Fig. 18). An evacuation is 
not desired until the following morning, when 
the child is placed at stool after his breakfast 
and allowed to remain fifteen minutes. If no 




FIG. l8. THE BULB SYRINGE 

evacuation occurs at the end of this time, a 
slight stimulation in the use of a suppository 
or soap-suds may be used to bring it about. 
In a comparatively few days usually the morn- 
ing evacuation takes place without assistance. 
The oil should be continued for several days, 
when it may be omitted one night in seven. 
When an evacuation follows the next morning, 
it may be omitted one night in five. In this 



268 Vaccination 

way the oil may be gradually lessened until it 
is no longer required. In some children a small 
amount of the oil will be passed during the 
night. These should wear a napkin. At this 
age also the liquid albolene (aromatic) may 
be used in dosage of one to two tablespoonfuls 
at bedtime. 

VACCINATION 

Every baby in fair health should be vac- 
cinated not later than the third month — before 
any trouble incident to dentition may arise; 
for the younger the child, the less the consti- 
tutional disturbance. Vaccination in a child 
two to three months of age causes practically 
no illness whatever. Both sexes should be 
vaccinated on the outer side of the calf of the 
leg: girls, because the resulting scar on the 
arm may be regarded, in later life, as a dis- 
figurement; and both boys and girls, because 
when the sore is on the leg it is more easily 
cared for. In dressing and undressing a child, 
the arm has to be manipulated to a considera- 
ble extent, thus causing more or less discom- 
fort. 

Management of the wound. — The wound 



Vaccination 269 

should be kept covered with a sterilized gauze 
bandage until the crust falls, leaving the dry 
pink skin underneath. Tub bathing should be 
discontinued until this takes place. 

Vaccination shields are all worse than use- 
less; they are often positively harmful, for 
they usually become displaced and may irri- 
tate and infect the sore. When unpleasant 
results follow the vaccination, the virus is 
rarely at fault. The infection is usually due 
to carelessness or to uncleanliness in the treat- 
ment of the wound. 

Necessity of vaccination. — Vaccination will 
always be considered by people who enjoy the 
possession of an ordinary amount of knowl- 
edge and a moderate amount of common-sense 
as one of the greatest discoveries of medical 
science. Since its discovery by Jenner, as 
statistics show, millions of lives have been 
saved by vaccination. It would seem strange 
that one should feel it necessary to speak in 
defence of a measure which has been of such 
incalculable value to the human race, but there 
are a noisy lot of mentally incompetent anti- 
vaccinationists, who are not without influence 
among their kind and the otherwise ignorant, 
upon whom the following statistics by Allen 



270 Bed-Wetting 

{Pediatrics, February, 1900) would produce 
no effect : 

In 1 87 1, Germany lost one hundred and 
forty-three thousand lives by smallpox; in 
1874, a law was enacted making vaccination 
obligatory during the first year of life and 
compelling its repetition during the tenth year. 
The result was that the disease almost entirely 
disappeared. At the present time the loss of 
life from this disease throughout the empire 
is scarcely one hundred a year. At the time 
of the Franco-Prussian War, the entire Ger- 
man Army was re-vaccinated; while in the 
French Army, vaccination being optional, 
comparatively few were vaccinated. Both 
armies were attacked by smallpox, the French 
losing twenty-three thousand men, the Ger- 
man, two hundred and seventy-eight. With 
such statistics how can there be any plausibility 
in the argument of the anti-vaccinationists ? 

BED-WETTING 

The urine is voided involuntarily by most 
children until well into the second year. If 
the child is carefully trained, the function of 
urination may be under perfect control dur- 
ing the waking hours by the end of the first 



Bed- Wetting 271 

year. We hear now and then of a child who 
urinates voluntarily at the age of six months. 
Such children are rare. The urine is passed 
normally during sleep until the child is two and 
one-half or three years of age. In many this 
will be controlled at the end of the second year, 
but I do not regard the lack of control as an 
abnormality until the third year is reached. If 
the urine is passed involuntarily after the child 
is three years old, a physician should be con- 
sulted, not necessarily to give drugs, but to 
instruct the mother as to the diet and general 
hygiene. 

Causes of bed-wetting. — Incontinence of 
urine may be due to a great variety of causes, 
among which may be mentioned a highly acid 
urine, stone in the bladder, which is of com- 
paratively rare occurrence, adenoids, thread- 
worms, constipation, inflammation of the vulva 
and vagina in girls, and tightly adherent fore- 
skin in boys. By far the greatest number of 
cases, however, are due to a lack of develop- 
ment of the nervous system and, in addition, 
a bad habit. Not infrequently the trouble is 
caused by over indulgence in water and milk 
late in the afternoon and during the night. It 
is rarely a symptom of kidney or bladder dis- 



2*]2 Bed-Wetting 

ease. The relief of the inveterate bed-wetter 
of five or six years of age is often most diffi- 
cult. The child must be examined by a physi- 
cian to determine that there is no local cause 
for the trouble. If no such cause is found, 
well-directed medication, with the mother's co- 
operation, will usually relieve the patient, al- 
though it may require months to do it. In 
the cases of only occasionally bed-wetting, and 
with younger patients, the mother alone can 
often accomplish considerable. 

Management. — No water or milk should 
be given after four o'clock p.m. The child 
should have a dry supper, for which I would 
suggest farina, hominy, or rice, any of which 
may be served with butter and a little sugar. 
If the child will not take the cereals without 
milk, a very little may be added. This with 
stewed fruit and a piece of bread is sufficient. 
The child's bedclothing should be light, and 
he should be made to sleep on his side, not 
on his back. In order to prevent the child 
resting on his back, tie a piece of any thin 
goods about the chest, with a large knot be- 
tween the shoulders. The child should always 
be taken up at ten or eleven o'clock and made 
to urinate. 



Care of the Genitals 273 

If there is phimosis, vaginitis, thread-worms, 
or any local disorders, treatment of the local 
conditions may effect a cure. 

Incontinence during the day. — A few bed- 
wetting- children are troubled with incontinence 
during the day as well. There is a constant 
leakage, the clothing being wet the greater 
part of the time. The management of these 
cases, however, differs in no respect from that 
advised for those first mentioned, except in 
the matter of medication, which can be carried 
out only by a physician. 

CARE OF THE GENITALS 

PAINFUL MICTURITION, CIRCUMCISION 

In girls very little care of the genitals is 
required other than cleanliness. The parts 
should be washed in boiled water and Castile 
soap once a day. Sponges should not be used. 
Soft old linen is far better, and after once 
using it should be burned. A sponge is never 
clean after it has once been used, and should 
have no place in the nursery outfit. After 
cleansing, the parts should be dusted thor- 
oughly with the following powder : boracic 



274 Care of the Genitals 

acid ten grains, powdered starch and oxide of 
zinc each one-half ounce. 

With boys more attention is required. The 
normal condition, a free foreskin, non-adherent 
to the glans penis, is necessary for his comfort 
and health. It should be stripped back once a 
day and the parts washed very gently with 
Castile soap and warm water, dried with ab- 
sorbent cotton, and a bit of vaseline applied. 
In the majority of boys the foreskin at birth 
is tightly adherent to the glans, with only a pin- 
hole opening. Such a condition is one of much 
annoyance to the child. Secretions which act 
as a foreign body form under the foreskin, 
producing no little irritation, drawing the 
child's attention to the parts, and thus often 
leading directly to the habit of masturbation. 
Inflammation of the foreskin and orifice of the 
urethra not infrequently follows this condition. 
As a result, urination is painful and the urine 
is retained until the child cannot pass it. I 
have known children for this reason to hold 
their urine for over twenty-four hours. I have 
known pus to form under the foreskin, neces- 
sitating immediate operation. In two boys 
aged about two years, repeated convulsions 
occurred, for which no reason could be as- 



Retention of Urine 275 

signed other than the irritation caused by the 
tightly adherent foreskin and the retained se- 
cretions. They were circumcised and have 
been perfectly well since. Bed-wetting is often 
a direct outcome of this trouble. 

Necessity of circumcision. — Four out of 
five of the boys who come under my care need 
circumcision. This does not mean that four 
out of five are circumcised, as family objec- 
tions are often hard to overcome, even where 
the physician is convinced that such a measure 
would be beneficial. In a very few cases, 
stretching and retracting the foreskin may 
answer every purpose. But such cases are 
rarely properly attended to afterward ; no mat- 
ter how careful the instructions given, the adhe- 
sions are allowed to re-form, and in a short 
times all the annoying symptoms return. The 
daily manipulation of the parts necessary for 
cleanliness is for obvious reasons to be avoided 
if possible. When a child is properly circum- 
cised he is relieved for all time. 

RETENTION OF URINE 

This condition often greatly alarms mothers. 
In girls, the most frequent cause is pain due 



276 Retention of Urine 

to the inflammation of the urethral orifice and 
the adjoining parts, which may have been 
caused either by excessive acidity of the urine, 
or by vaginitis. Retention sometimes results 
from taking cold; high fever is sometimes a 
cause, and, in some instances, no cause can be 
discovered. 

In boys the retention may be due to urethral 
irritation produced by excessive acidity of the 
urine; far more frequently, however, the 
trouble is caused by an inflammation of the 
foreskin, which is often swollen to three or 
four times its normal size. In these cases the 
orifice of the urethra will usually be found red 
and swollen. In either sex, if there is reten- 
tion of the urine for over sixteen hours, place 
the child in a tub of warm water at a tempera- 
ture of no°F., and often urination will fol- 
low immediately. Another useful method oi 
treatment consists in the application to the 
parts of cloths wrung out of hot water. Per- 
haps the best results are obtained by the use of 
an enema of a normal salt solution — a tea- 
spoonful of salt to a pint of water — at a tem- 
perature of no F. ; at least a pint should be 
used for this purpose and the child allowed to 
retain it if he will. This treatment rarely fails. 



Worms 277 

If it does, the doctor must use the catheter. 
The swelling of the parts in boys is best re- 
duced by a wet dressing of a saturated solution 
of boracic acid, which is applied on old linen 
wrapped around the parts and changed every 
half-hour. In girls a simple pad composed of 
several layers of old linen should be saturated 
with the boracic acid solution and similarly 
applied, the dressing being changed every hour, 
and the parts gently bathed with the solution. 

WORMS 

There are three varieties of worms com- 
monly met with in children : the round-worm, 
the thread-worm, and the tape-worm. 

Round-worms occur most frequently in 
children from two to ten years of age, although 
no age is exempt. When a child picks its nose, 
grinds its teeth at night, sleeps poorly, has a 
coated tongue, and an indifferent appetite, it is 
supposed by the older members of the family 
to have "worms." These symptoms may indi- 
cate the round-worms, but they far more fre- 
quently indicate a too close acquaintance with 
gingerbread and jam and other cupboard, be- 
tween-meal indulgences. Frequent attacks of 



27% Worms 

colic, constipation, alternating with diarrhoea 
and convulsions are, in my judgment, the most 
reliable symptoms of round-worms. The only 
positive means of diagnosis, however, is the 
discovery of the worm itself, or the presence 
of the eggs in the stools. The round-worm 
resembles the common earth-worm. It is 
usually from five to nine inches in length and 
inhabits the small intestine. Round-worms are 
seldom seen among city children; in the coun- 
try, however, they occur with much greater 
frequency. 

Thread-worms inhabit the lower portion of 
the large intestine, and in appearance are like 
pieces of white thread. They are usually 
from one-quarter to one-half inch in length. 
They are very frequently seen among the chil- 
dren of the tenements. Occasionally they oc- 
cur in children of the well-to-do. 

The chief symptom of these worms is an 
itching or irritation about the anus. The child 
is restless and sleeps poorly. In girls there 
may be a vaginal discharge due to the irrita- 
tion caused by the worms, which have migrated 
to these parts. Frequently the only symptoms 
of discomfort will be manifested when the 
child is put to bed. He will then complain of 



Worms 279 

a biting, burning sensation in the rectum. In 
some, the rectal irritation is so great as to 
cause very pronounced nervous symptoms. 

Several years ago I treated a six-year-old 
girl for involuntary movement of the arm and 
shoulders somewhat resembling St. Vitus's 
dance. The trouble disappeared after several 
weeks' treatment for the thread-worms which 
were present in large numbers. I have seen 
many cases of prolapse of the bowel due to the 
straining which was caused by the irritant ac- 
tion of the worms. In both sexes they may 
be a cause of bed-wetting and in the girls are 
not an infrequent cause of masturbation. In 
some instances after treatment the worms will 
be passed in great numbers in the stools, and 
may sometimes be seen adhering to the skin 
of the parts. 

Tape-worms in children are very rarely 
seen in this country. I have seen about fifteen 
cases among many thousands of children 
treated during the past thirty years. The pres- 
ence of the tape-worm is indicated by various 
indefinite manifestations. Constipation alter- 
nating with diarrhoea are prominent symptoms. 
The child is often ravenously hungry. A posi- 
tive diagnosis can be made only after the dis- 



280 Excitement 

charge of segments of the worm, which appear 
like short pieces of narrow white tape linked 
together. A physician should always direct 
the treatment. 

EXCITEMENT 

A baby should not be subjected to excite- 
ment or its equivalent — too active entertain- 
ment. The nervous system of an infant is 
in such an undeveloped state that what would 
be a decided tax upon it cannot be appreciated 
by adults, who are often apparently insensible 
of the fact that children are different from 
themselves. 

The first child in a well-to-do family is 
usually the greatest sufferer from superfluous 
attention, — being a source of unending ad- 
miration on the part of the family and friends. 
He is often present very early in life at all 
important functions. Christmas, Thanks- 
giving, birthday celebrations, and afternoon 
teas find him the centre of attraction. He is 
handed from one guest to another and is tossed 
upon various angular knees. He is kissed by 
lips which dare touch only those who cannot 
protect themselves. He is talked to with a 



Kissing 281 

very loud voice in a very silly manner and 
grimaces horrible to witness are made at him. 
I have witnessed such scenes, and have treated 
exhausted infants who require medical atten- 
tion after the seance was over. I have, indeed, 
seen infants thus brought to the verge of col- 
lapse. One child of eleven months had con- 
vulsions which were indirectly due to fatigue 
incident to a Thanksgiving celebration. 

KISSING 

A child should never be kissed on the mouth. 
I have known, in my own private practice, of 
instances where tuberculosis, diphtheria, and 
syphilis have been communicated from the dis- 
eased adult to the child by this practice. 
Neither should the child's hands or fingers be 
kissed, as the hands and fingers of the ma- 
jority of babies are in their mouths many 
times an hour. If baby is the first one that has 
graced the household, and must be kissed, this 
can be accomplished with the least damage if 
the kiss is implanted on the head or forehead. 
The parents must make the rule, and they must 
set the example by adhering to it themselves. 

Among my patients, a nurse who is known 



282 Sleep 

to have kissed the child is punished by dis- 
missal. Because an adult is apparently well 
is no excuse for this indulgence. Healthy 
adults frequently have in their mouths the 
germs of tuberculosis, of diphtheria, of grippe, 
and of other diseases, and never suffer from 
their presence because they are strong adults 
with vigorous mucous membranes which do 
not furnish as favorable a soil for the growth 
and development of pathogenic bacteria as do 
the more delicate mucous membranes of the 
young. It is criminal, therefore, to subject the 
child to such dangers. Scarlet fever, measles, 
and whooping-cough are all most readily trans- 
mitted at the beginning of an attack through 
the close contact required by a kiss. 

SLEEP 

The infant that sleeps well is almost always 
a normal, well-fed baby. Irritability and 
sleeplessness are associated with indigestion 
more frequently than with any other disorder. 
During the first few days of life the sleep, 
in normal conditions, is almost unbroken, ex- 
cept when the infant is fed. During the first 
month the infant sleeps about twenty-two 



Sleep 283 

hours out of every twenty-four; during the 
second and third months, from twenty to 
twenty-two hours. At the sixth month the 
child should sleep from 6 p.m. to 6 a.m. with- 
out interruption other than for feeding or 
nursing, which need cause very little dis- 
turbance. At this age there should be a two- 
hour nap during the morning and a two-hour 
nap in the afternoon, although it is not well 
to have the baby sleep after three o'clock in 
the afternoon. The twelve-hour night rest 
should be continued until the child is six years 
of age. The day naps will gradually be short- 
ened hy the child. At one year of age, one 
hour in the morning and two hours in the 
afternoon suffice. From the eighteenth month 
to the second year, the morning nap is given 
up. Afternoon rest for at least one and one- 
half hours should be continued until the child 
is six years of age, and longer if he is inclined 
to be delicate. Regular sleep is largely a mat- 
ter of habit, and if the infant is started right, 
with suitable feedings given at definite times, 
followed by the proper period of sleep, but 
little trouble will be experienced with sleepless- 
ness. When sleep is disturbed and broken, it 
means bad habits, unsuitable food, minor forms 



284 Crying 

of indigestion, or positive illness of some kind. 
Sleep is important for purposes of growth not 
only in early infancy but throughout childhood. 
Not a few infants form habits of sleeping in 
the daytime and being wakeful at night. This 
is best remedied by keeping the baby awake 
when he should be, during the day, by enter- 
tainment and by keeping him in a well-lighted 
room. I am sure that the satisfactory results 
I have had the good fortune to achieve in the 
treatment of secondary malnutrition and ane- 
mia have been due in part to my insistence that 
the child sleep in a quiet, darkened room for 
two hours after the noonday meal. The energy 
expended in twelve hours by an active child 
is incalculable, and when a portion of this 
energy is reserved and the body fortified by 
rest and sleep during the middle of the day, 
it means a greatly diminished daily expenditure 
of strength units. 

CRYING 

It is well for the young infant to cry a little 
every day. Muscular movements involving 
a greater part of the body accompany the act 
of crying and furnish exercise. Peristalsis is 



Crying 285 

increased, as is often evidenced by a move- 
ment of the bowels occurring at the time, par- 
ticularly when there is diarrhoea. In crying, 
deep breathing is necessary, the lungs are ex- 
panded, and the blood oxygenated. The well 
baby cries when frightened, or uncomfortable 
from hunger, soiled napkins, or inflamed but- 
tocks. He cries from pain, from heat, from 
cold, from unsuitable clothing, and during diffi- 
cult evacuation of the bowels. He also cries 
when displeased or angry. Authors are prone 
to refer to the diagnostic value of an infant's 
cry. It is my belief that characteristic cries 
are not to be depended upon sufficiently to give 
them a differential diagnostic dignity. Children 
slightly but painfully ill may cry incessantly 
for an hour or two. Thus, with intes- 
tinal colic, where the cry is loud and continu- 
ous until the child is relieved or until he falls 
asleep from exhaustion. Earache is not an 
infrequent cause. The habitual criers, the rest- 
less and vigorous crying, whining infants, are 
uncomfortable. With very few exceptions the 
trouble will be found in the intestinal tract. 
The well-trained, normal child, whose nourish- 
ment is suitable, is seldom troublesome. When 
well, all babies are naturally good-natured and 



286 Cleanliness 

happy in their own way. Badly managed, 
spoiled infants often cry vigorously when left 
alone. When attention is given them, when 
they are taken up and talked to, the crying 
ceases. This readily tells us that pain or dis- 
comfort was not an element in causing the cry. 
In these infants, discipline, not medication, is 
needed. The management of the habitual crier 
involves the relief of the condition which causes 
the discomfort, or the most rigid discipline. 

CLEANLINESS 

Much has been said and written regarding 
the necessity of cleanliness so far as the child 
is concerned; but not only should the nurse 
and mother see that the baby is clean; they 
must be clean themselves. Immediately after 
every attention to the napkin the hands should 
be washed with hot water and soap and a stiff 
brush. This cleansing process must be re- 
peated before the preparation of the food or 
any manipulation of the feeding apparatus. 

The child's attendants should not have de- 
cayed or neglected teeth. The tooth-brush 
should be an important article in the outfit of 
every nurse. She should take a tub-bath or 



Cold Hands and Feet 287 

sponge-bath daily. The hands and finger- 
nails of many nursery-maids will bear watch- 
ing. 

COLD HANDS AND FEET 

The hands and feet of the infant should 
never be cold to the touch. This is a cause 
of much of his discomfort and restlessness. 
A very young child with poor circulation will 
be made much more comfortable by placing a 
hot-water bag at his feet. Bottles filled with 
warm water and wrapped in flannel will keep 
the upper extremities warm. In using the hot- 
water bags and bottles be sure that the water 
is not too hot. Severe burning accidents have 
resulted from carelessness in this particular.- 

An excellent means of keeping premature 
or delicate babies warm is in the use of the 
"Electrotherm" (Fig. 12). These small 
heaters are attached to an electric fixture, like 
a drop-light. A convenient size is from ten to 
fifteen inches. It is placed between two or 
three thicknesses of blankets, upon which the 
infant lies in its basket or crib. The degree of 
heat can be regulated according to the amount 
of electricity turned on. 



288 Flies and Mosquitoes 

FLIES AND MOSQUITOES 

The windows of the nursery should be 
screened so that flies and mosquitoes cannot 
enter. When out of doors the very young 
child should be protected by mosquito-netting. 
Mosquitoes severely poison many children, and 
are of especial danger in that one variety is 
capable of inoculating the child with malaria, 
the Plasmodium malaria? being deposited along 
with the other poison. 

Flies, in addition to disturbing sleep, are a 
source of much danger which is but little ap- 
preciated. The fly enters the nursery and 
alights on the nipple of the nursing-bottle. 
This may take place while the child is resting 
for a second or two during his meal, as flies 
are very fond of the sweet milk which may 
adhere to the nipple ; or the fly may alight upon 
the child's bread, or the prepared cereal, or 
any article of food, particularly if there is a 
sweet element in it. The last place the fly 
rested before reaching the nursery we never 
know. It may have been on animal excrement, 
or tubercular sputum, or the infectious dis- 
charges of a typhoid-fever patient. In this way 
the flies' feet and legs are the means of trans- 



Germs 289 

porting the germs of typhoid fever or diph- 
theria. Tuberculosis is unquestionably trans- 
ferred in this way very frequently, minor ail- 
ments with still greater frequency. Flies are 
a source of danger in the house, and should be 
driven out or destroyed. 

GERMS 

What need has the mother to know about 
germs? She, of all persons, should know be- 
cause nearly all the illnesses of an infant and 
child life are due to invisible bodies, some so 
tiny that the most powerful microscope fails to 
detect them. 

The following is a list of some of the diseases 
which have been proven due to germs or bac- 
teria : 

Consumption (Tuberculosis), 

Meningitis, 

Cholera, 

Typhoid fever, 

Infantile paralysis, 

Diphtheria, 

Whooping-cough, 

Cholera infantum, 

Dysentery, 

Summer diarrhoea, 

19 



290 The Doctor 

Grippe, 

Pneumonia, 

Bronchitis. 

Scarlet fever, smallpox, measles, mumps, 
chicken-pox, and others are of germ origin, 
but the particular germ causing each disease 
has not been proven. 

Boiling, sterilizing, and the use of soap and 
hot water for scrubbing purposes, together 
with sunlight and fresh air and the destruc- 
tion of flies, mosquitoes, and other insects are 
the great means of combating germ life. 

WHEN TO SEND FOR THE DOCTOR 

This question is easily answered. Send 
for the doctor when there are any indica- 
tions of illness in the child which the mother 
does not understand. It is better to be over- 
cautious in this respect than to join the great 
number of mothers who are never free from 
the bitter, life-long regret, "The child might 
have been saved had he been treated in time." 
I know such mothers. 

There are two conditions in which the 
mother must not trust herself for a moment. 
These are summer diarrhoea, and sore throat. 



First Aid to the Baby 291 

"Only a summer diarrhoea," and "only a 
sore throat," and "only a teething diarrhoea," 
have sacrificed the lives of hundreds of infants. 
Diphtheria is a very prevalent disease, and 
the successful treatment of it requires that 
the child be seen by the physician at the 
earliest possible moment. So, also, with sum- 
mer diarrhoea. I have seen infants die in 
twelve hours with the disease. Calling a doc- 
tor early is a means not only of safety, but of 
economy. In the correction of slight ailments, 
grave ones are avoided. 

FIRST AID TO THE BABY 

Cuts. — Keep fingers, water, clothing, dust 
— everything away from the wound. Mix 
one teaspoonful of tincture of iodine with 
the same quantity of alcohol, and paint this 
solution on the skin about the wound, from 
the very edges of the wound to at least two 
inches away on all sides, provided of course 
that the part injured will permit of this wide 
application. Then apply a freshly ironed 
piece of linen and a bandage. This dressing 
must be kept in place. 

Bruises and bumps. — Apply cloth wrung out 
in cold water. Change frequently. 



292 First Aid to the Baby 

Sprains. — Wrap a bandage around the part 
and keep wet with cold water in frequent ap- 
plication. If the injured part is a lower 
extremity, keep it elevated on a plane with the 
body. 

Cuts, bruises, and sprains of consequence 
require the early attention of the family 
physician. 

Burns. — If the skin is merely reddened, 
apply vaseline or sweet oil on clean linen. If 
the skin is blistered or charred, do not apply 
any oily substance. Sprinkle boric acid powder 
over the parts and cover with clean linen until 
the physician arrives. 

Bites of animals. — Bites of animals are 
rarely serious. Hundreds of individuals are 
bitten by dogs and cats every year without 
other harm than that of the wound inflicted. 
Apply at once on old linen a solution of one 
teaspoonful of carbolic acid in one pint of 
water or one ounce of boracic acid in one pint 
of water. Keep this dressing wet on the 
wound until a physician is seen. 

Bites of insects. — Bites of insects may be 
dangerous. Mosquitoes can transmit malaria 
and yellow fever. Insect bites, although inno- 
cent of great harm, cause a great deal of dis- 



First Aid to the Baby 293 

comfort through itching and temporarily dis- 
figure the child. The itching attending insect 
bites particularly in the case of mosquitoes is 
greatly relieved by painting the parts with 
collodion containing 10% solution of tincture 
of iodine. Frequent applications of witch hazel 
are helpful in relieving the patient. 

Fever. — The onset of sudden fever is to be 
met by a dose of castor oil, one to two tea- 
spoonfuls, a bowel irrigation (p. 109) if there 
has been constipation, and a sponge bath (p. 
114) with cool water. The sponging may be 
continued for from fifteen to twenty minutes. 

Colic. — An attack of colic is best relieved 
by a bowel irrigation (p. 109) , by giving sips or 
teaspoonful doses of quite hot water. A 
soda mint tablet dissolved in one ounce of 
hot water and given in teaspoon doses every 
five minutes will relieve many cases. The food 
should be temporarily discontinued and water 
given. If the child has colic habitually it 
means that the food given needs the attention 
of a physician. 

Convulsions. — While awaiting the physician 
place the baby in a warm bath and rub the body 
vigorously while in the bath. If mustard is 
at hand add two teaspoon fuls to the water used. 



294 First Aid to the Baby 

The great majority of convulsions are due to 
indigestion and constipation. Give the baby 
an enema as soon as possible, perhaps while 
in the bath. As soon as the baby can swallow 
give two teaspoonfuls of castor-oil. For a 
few days following, a greatly reduced diet 
should be given. 

Earache. — ist. Drop warmed sweet oil into 
the ear. Test it in your own ear first to insure 
its not being too hot. 

2d. Rest the affected side on a hot-water bag. 

3d. Syringe the ear (page 117) with water 
at no F. If a thermometer is not at hand, 
have the water quite warm and test the heat 
of the water in your own ear before using. 

Nose-bleed. — The child should sit erect, not 
lie down. The nose should be firmly com- 
pressed between the thumb and finger for 
several minutes. The tips of the thumb and 
finger should touch the lower portion of the 
nasal bones. After the bleeding is controlled 
in this way, a small piece of ice should be 
wrapped in a handkerchief and held against the 
affected side. Repeated hemorrhage usually 
means that an ulcer is present in the nostrils 
and needs active treatment. 

Foreign bodies swallowed. — Foreign bodies 



First Aid to the Baby 295 

swallowed by infants and young children rarely 
cause harm. Do not give a laxative. Give 
starchy substances such as oatmeal, potato, 
cornmeal mush, substances which may form 
a semi-solid mass in the intestine in which the 
object swallowed may become imbedded and 
carried forward. 

Foreign bodies in nose and ear. — A foreign 
body in either nostril may sometimes be re- 
moved by making pressure over the unob- 
structed nostril and then directing the child 
to blow the nose vigorously. 

Substances not thus removed, as well as for- 
eign bodies in the ear, should be removed only 
by a physician. 

Prickly heat. — Prickly heat is best treated 
by sponge baths of bicarbonate of soda, one 
tablespoonful to two quarts of water. Do not 
rub the skin in drying. Several times a day 
dust the skin thoroughly with a powder com- 
posed of equal parts of powdered starch and 
oxide of zinc, obtained at the druggist's. Chil- 
dren with prickly heat should wear thin gauze 
or linen underwear. Wool should not be worn. 

Croup. — There are two kinds of croup, 
catarrhal or spasmodic and diphtheritic or 
membranous croup. 



296 First Aid to the Baby 

Croup always calls for the immediate atten- 
tion of a physician. While waiting for the 
doctor, give the patient a teaspoonful of syrup 
of ipecac to be repeated in 15 minutes, if 
vomiting does not occur. The child is much 
relieved by vomiting, if the case is one of 
spasmodic croup. Steam inhalation from a 
croup kettle or a tea-kettle are of much service. 
Care must be exercised not to burn the child. 

Sore throat. — A mother must never attempt 
to treat a sore throat in a child. Diphtheria 
usually begins with low fever and a slight sore 
throat. A physician should be called in every 
case of sore throat in a child. I could give 
many instances in which children have died 
with diphtheria because of neglected "home- 
treated" sore throat. 

The swallowing of poisons. — Unfortunately 
children are sometimes given the wrong medi- 
cine, or given some poisonous substance instead 
of the medicine intended. I have known chil- 
dren to swallow poisonous tablets and pills in- 
tended for adults. Under such circumstances 
the child should always be made to vomit. This 
can be done by gagging the child through forc- 
ing the clean index finger low in throat. If 
syrup of ipecac is at hand two teaspoonfuls 



Patent Medicines— Resorts 297 

may be given, which will be sufficient to pro- 
duce active vomiting. The physician must be 
called at once in all cases of poisoning. 

PATENT MEDICINES 

Patent medicines should form no part of 
the nursery outfit. The mother's home reme- 
dies should all be approved by a physician. 
Cough mixtures and soothing syrups, the ad- 
vantages of which are so faithfully portrayed 
in the popular magazines and religious periodi- 
cals, are often very harmful. Most of them 
contain alcohol, opium, or morphine. Time 
and again I have seen children drugged to the 
point of stupor by these remedies. 

SUMMER RESORTS 

Where to take the child for the summer is 
a vexed question which arises once a year in 
many households. Several years of observa- 
tion of a great many children who have spent 
the summer out of town have led me to the 
following conclusions : 

1. The most desirable summer outing: the 
first half of the season at the seashore, the re- 
mainder inland, preferably in the mountains. 

2. The next in order of desirability : in- 



298 Summer Resorts 

land, preferably the mountains for the entire 
summer. 

3. The least desirable : the seashore for the 
entire summer. 

I do not wish it understood that many chil- 
dren will not do well at the seashore if kept 
there the entire summer; some, indeed, im- 
prove wonderfully; but among my own 
patients I have been repeatedly impressed with 
the disadvantages of a prolonged outing by 
the sea. The seashore children, as a rule, do 
not return to the city in the fall with the vigor, 
appetite, and general robustness which charac- 
terize those who return from the mountains. I 
refer only to New York children, whose home 
is a seaport, and who thrive best when given 
the advantage of a complete change to the dry, 
invigorating air of the mountains. Children 
with catarrhal tendencies, adenoids, bronchitis, 
and rheumatism, and those convalescent from 
pneumonia, should not go to the seashore. 

In selecting an inland resort, the mountains, 
by which we understand an elevation of from 
fifteen hundred to two thousand feet, are not 
always necessary. The place selected, how- 
ever, should have an elevation of at least six 
hundred feet, and should not be within sixty 



Drug-Giving 299 

miles of the coast. Children who are subject 
to rheumatism and bronchitis do best on a 
sandy soil, in a dry climate, with the sleeping 
rooms above the ground floor. 

Another point to be considered in this con- 
nection is the kitchen facilities which will be 
provided for the preparation of the child's 
food. As a rule, the larger hotels refuse the 
right of way to the kitchen; or, if they do not, 
it is at the expense of many material atten- 
tions to the chef. I find that mothers are given 
much more latitude as to these matters in the 
smaller hotels and boarding-houses. The 
proper preparation of a child's food in the 
cramped quarters of the sleeping apartment 
is not impossible, but it is very difficult. 

Before selecting a summer home, the drain- 
age, the milk, and the water supply must be 
considered. If the parents possess the means, 
a cottage should be rented, which will insure 
them all the comforts of home. Country well 
water or spring water should always be boiled 
before using. 

DRUG-GIVING 

Drugs are of service only in the hands of 
those who are trained in their use. Mothers 



300 The Daily Outing 

often acquire the habit of treating their chil- 
dren. Self-prescribing is greatly overdone in 
this country among all classes. Many people 
know just enough about medicines to be dan- 
gerous members of society. The proprietary 
cough mixtures, soothing syrups, teas, car- 
minatives, etc., are often injurious. They 
usually contain opium, — a drug which a mother 
should never think of giving her baby on her 
own responsibility. It is not at all uncommon 
in hospital work to have children admitted in 
an opium stupor which resists all treatment 
for hours. 

While the habit of promiscuous drug-giving 
is to be condemned, the mother is not supposed 
to remain inactive while awaiting the arrival 
of the physician; a preliminary dose of castor- 
oil in diarrhcea, or syrup of ipecac in croup, or 
rhubarb and soda when there is a furred tongue 
in indigestion, will always be in order. The 
mother may have her home remedies, but the 
physician must instruct her in their use. 

THE DAILY OUTING 

The baby should not go out in stormy 
weather. If under one year of age he should 



Indoor Airing 3° l 

not go out if the temperature is below 20 F. 
During the midday heat of summer the baby 
is better off in the largest and coolest room in 
the house or on a shady veranda. On very 
windy days the outing should be postponed. 
When the snow is melting in large quantities 
the baby is better off indoors. 

INDOOR AIRING 

For this purpose the child is dressed as for 
the daily outing. All the windows of the nur- 
sery or some other large room are opened, on 
one side of the room only. The doors should 
be closed, so that currents of air are avoided. 
The child is placed in his carriage, suitably 
covered, and wheeled about the room for an 
hour or two. This, if done twice daily, an- 
swers almost as well as the actual outing. 

This method will be found very useful in 
"winter babies" — those born during the late 
fall or winter months. The indoor airing 
may be given for a week or more, before he 
is taken out. By this means the child is grad- 
ually accustomed to a change of the tempera- 
ture from that of the average living-room to 
that of out-of-doors, and will not be harmed 



302 Children's Parties 

when he is finally taken out. After an illness, 
it will afford an earlier means of returning to 
the daily outing. This method of giving a 
child fresh air will be found useful with very 
delicate children, who, by reason of their con- 
dition, may be unable to go out during the 
winter months for several weeks at a time. 
There are, however, but few days during the 
winter that are too cold or too stormy for the 
indoor airing. 

CHILDREN'S PARTIES 

Parties for children under the sixth year 
of age are to be discouraged. The important 
features of a child's party are entertainment 
and the "banquet." There are two features of 
child life that are important to guard against — 
excitement and injudicious feeding. Exciting 
play and unusual articles of food at an unusual 
time appear to be a necessary part of a so- 
called children's party. The bringing together 
of children of tender age is further to be dis- 
couraged because it increases their liability to 
contract the contagious diseases from which 
every child should be protected to the full ex- 
tent of our ability. 



Baskets for Early Exercise 3°3 

Not long since a patient — a little boy four 
years old — invited fourteen little boys and 
girls of corresponding ages to celebrate his 
birthday. The little host was more generous 
than was his wont; he gave more than the 
banquet! The night of the birthday party he 
was very uncomfortable. The following day 
he developed chicken-pox. In due course of 
time twelve of the fourteen little guests came 
down with chicken-pox. They were fortu- 
nate that it was only chicken-pox; it might 
have been scarlet fever or diphtheria. 

I regret that I have not kept a record of 
the acute illnesses that have followed children's 
parties under my immediate observation. 
Acute indigestion, diarrhoea, convulsions, and 
all of the contagious diseases of childhood 
would be found in generous numbers in such 
a record. 

BASKETS FOR EARLY EXERCISE 

It is a great mistake to have the infant con- 
stantly in arms. The first baby suffers more 
in this respect than later children. When the 
child is held, there is always a tendency to make 
him sit on the arm or knee without proper 



304 Baskets for Early Exercise 

support, or to toss about or handle him re- 
gardless of consequences. The bones and liga- 
ments of the spinal column are not sufficiently 
developed to bear the weight of the heavy head 
and trunk, and, as a result, as the child grows 
older, spinal curvature and other deformities 
not infrequently follow. By urging him to 




FIG. 19. BASKET FOR EARLY EXERCISE 

stand on the lap the legs are used more than 
is advisable, and we find bow-legs or knock- 
knees very prevalent. 

A large clothes-basket, in which a thick 
blanket has been placed (see Fig. 19), 
furnishes a safe and satisfactory playground. 
For the first few months the child will rest on 
his back and amuse himself in his own pecul- 
iar way. When he can sit up, supported by 



Night Terrors 305 

a pillow at his back, the basket gives him 
plenty of room for toys and other baby re- 
quirements. In it the baby is practically safe. 
He is not apt to be injured by young members 
of the family in rough play. He cannot crawl 
to the stove to be burned, and is in no danger 
of rolling down-stairs. When he can stand 
and begins to walk, the basket period is at an 
end. 

NIGHT TERRORS 

The child awakens suddenly from sleep, 
cries out with fear, and begs to be protected 
from men and animals, which he imagines are 
trying to injure him. In some cases the nurse 
and immediate relatives of the family will not 
be recognized. The seizures may occur quite 
regularly every night until the cause is re- 
moved. Other children may have but one or 
two attacks in a week. The seizures are 
usually due to a disordered digestive tract in 
a nervous child. Adenoids and enlarged ton- 
sils are considered by some to act as a predis- 
posing cause. Anxiety regarding school 
duties, or overwork at school may help to bring 
on an attack ; worms may also be a cause. My 



306 Scales for Weighing 

cases have all been due either to acute or 
chronic digestive disturbances in nervous chil- 
dren. A boy patient twelve years of age has 
had two attacks every year, with one exception, 
since he was six years old. These attacks 
always occur on the night after Christmas and 
his birthday, after indulgence in all sorts of 
unsuitable articles of food. 

During the attack the child must be treated 
with gentleness; scolding makes matters 
worse. If possible, he should be induced to 
go to sleep; oftentimes a change to the bed 
of the nurse or mother for the remainder of 
the night will be all that is necessary; or a 
light may be left burning in the room. The 
attacks may usually be prevented by a suit- 
able diet. The evening meal should be very 
light — a cereal with milk and a little stewed 
fruit is sufficient. This light supper has re- 
lieved several of my patients of habitual night 
terrors. Constipation is often an important 
factor, and when present requires treatment 
before relief is to be expected. 

SCALES FOR WEIGHING 

A scale for weighing the baby is a very 
necessary adjunct to the nursery furnishings. 



Scales for Weighing 307 

There are, on the market, several varieties 
of scales for weighing the baby, which are 
known as "baby scales." The usual construc- 
tion is that of a basket, into which the baby 




FIG. 20. SCOOP AND PLATFORM SCALES FOR WEIGHING 

is placed, supported by a rod which rests upon 
a spring. A needle indicates on a dial the 
weight of the child. The use of these scales 
is not to be advised. They get out of order 
easily, are expensive, and with a vigorous, 
kicking, crying baby, the rapid oscillations of 
the needle often prevent the weight being read 
with any degree of accuracy. Further, their 
weight capacity is but twenty pounds. When 
the child's weight reaches this figure, it necessi- 



308 The Exercise Pen 

tates the purchase of other scales. The scoop 
and platform scales used by grocers (see Fig. 
20) answer the purpose far better than any 
others. They do not get out of order, and 
weigh correctly from one-half ounce to two 
hundred and eighty pounds. The infant rests 
on his back in the scoop during the weighing 
process. Older children stand on the platform. 

THE EXERCISE PEN 

In a previous chapter, in speaking of cold 
and how children were exposed to influences 
which might bring about what is known as a 
"cold," the custom of allowing a child to sit 
on the floor is referred to. 

To keep a child from eight to twenty- four 
months of age off the floor during the winter 
months, and thereby prevent his taking cold, 
is a very difficult matter. In fact, with active 
children who are learning to walk, or who have 
just learned to walk, it is practically impossible. 
During this season of the year there is always 
a current of cold air near the floor, and allow- 
ing the child to creep on the floor in winter, 
even if it is protected by rug and pillows, is 
one of the surest ways of taking cold. If he 



The Exercise Pen 309 

is allowed to walk on the floor he is very sure 
to sit clown in a very few minutes. If he is 
not allowed to creep and walk about at will he 
will not get the proper exercise, and will show 
faulty development; for such cases I have 
found the exercise pen (see Fig. 21) of im- 
mense service. After being dressed, washed, 
and fed, the infant is placed in the pen on a 
rug or quilt, toys are given him, and the door 
closed. He can now roam about at will, stand 
up, sit down, roll, creep, or walk without dan- 
ger of physical harm from rolling down-stairs, 
being burned, or being stepped on. He is thus 
given an opportunity for active exercise with- 
out a possible chance of injury. 

A young mother of two children will take 
her "pen" into the country in the summer and 
place it in the shade for use while the dew is 
on the grass. In case the nursery is small it 
can be made so as to fit over the nurse's bed 
and consequently does not require any addi- 
tional space. In a large nursery it can be 
placed permanently in one corner of the room, 
thus avoiding the trouble of putting it up and 
taking it down. 

The pen can be made of any size, — 4 x 6 ft. 
is probably the most convenient, although 



Dont's 311 

several made 4x4 ft. are in use. It is so con- 
structed as to be taken apart and put together 
in a few moments, iron tenon hooks and iron 
mortices being used to hold the parts together. 
The floor may be made of any thin material. 
One-quarter inch pine boards nailed together 
so that the floor will be composed of two thick- 
nesses, or papier-mache supported by narrow 
strips of board, may be used. The floor is 
supported by strips of board about one-half 
by two inches, which are fastened to the inner 
side of the end-pieces. 

DON'TS 

Do not kiss the baby on the mouth or allow 
your friends to do so. 

Do not give soothing syrups or paregoric. 

Do not give proprietary cough medicines. 

Do not fail to secure the best milk you can 
afford to buy. 

Do not allow flies to rest on feeding bottle 
or nipple. 

Do not fail to wash the hands before pre- 
paring the food. 

Do not neglect to properly cleanse the bottle 
and nipple. 



3i2 Donts 

Do not allow the milk bottle to remain un- 
covered or off the ice. 

Do not fail to keep the food on the ice after 
it is prepared. 

Do not feed the baby at irregular in- 
tervals. 

Do not fail to change the napkin as soon as 
it is soiled. 

Do not fail to protect the baby from flies 
and mosquitoes by suitable mosquito netting. 

Do not give the baby a pacifier. 

Do not place the spoon or nipple to the lips 
before giving it to the child. 

Do not allow the baby to pick objects from 
the floor and place them in his mouth. 

Do not allow the baby to go one day without 
a bowel movement. 

Do not neglect the daily care of the 
mouth. 

Do not excite the baby during or immedi- 
ately after feeding. 

Do not raise the baby without supporting 
the back. 

Do not neglect to powder all folds of the 
skin. 

Do not neglect to keep the ice-box clean 
and filled with ice. 



General Instructions 3 X 3 

GENERAL INSTRUCTIONS 

How to give an enema. — Make a suds of 
water and Castile soap. Pour one pint water 
into the bag of a fountain syringe. Introduce 
into the anus the black rubber tip lubricated 
with vaseline. Raise the bag two feet above the 
child's head and allow the water in part or en- 
tire to pass into the intestine. 

How to cleanse the eyes. — Dip clean absorb- 
ent cotton in boracic acid solution, teaspoonful 
to one glass of water (dissolved with hot 
water) ; the solution may be used cool or luke- 
warm. Use a fresh piece of cotton for each 
eye. 

How to cleanse the baby's nose. — Wrap 
loosely a bit of absorbent cotton on a wooden 
toothpick. Dip the cotton in vaseline and with 
the baby's head held firmly introduce the cotton 
into the nostrils and through very gentle 
manipulation remove the crusts and secretions 
that may have formed there. Use fresh cotton 
for each nostril. 

How to syringe the ears. — Necessary arti- 
cles : A two-quart fountain syringe and a 
small basin. 

The child should be wrapped in a sheet with 



3H Food Formulas 

the arms bound to the side. He should rest 
on his back on the bed or couch. The basin 
protected by a towel is placed under the ear. 
Into the bag of the syringe is poured the solu- 
tion to be used for the douching. The bag is 
held three feet above the child's head. The 
small black rubber tip is held about one- fourth 
inch from the orifice of the ear canal and the 
solution allowed to flow. The ear should be 
drawn slightly backward and upward as this 
straightens the canal and allows of a freer flow 
of water. 

FOOD FORMULAS 

Beef-juice. — Broil round steak very rare, 
cut into small pieces, place in a meat-press, 
and press out the blood ; add a little salt. 

Beef, mutton, and chicken broth. — Take one 
pound of meat free from fat, cook for three 
hours in one quart of water, adding water 
from time to time, so that when the cooking 
is completed there will be one pint of broth. 
When the broth is cool, remove the fat, strain 
and add salt. 

Scraped beef. — Broil round steak slightly 
over a brisk fire. Split the steak and scrape 
out pulp, using a tablespoon. 



Food Formulas 3 1 5 

Egg-water. — The white of one egg, thor- 
oughly beaten in one pint of cold boiled water, 
strain, add a pinch of salt. 

Oatmeal jelly. — Oatmeal, two ounces ; water, 
one pint; boil for three hours in a double 
boiler, water being added, so that when the 
cooking is completed a thin paste will be 
formed. This while hot is forced through 
a colander to remove the coarser particles. 
When cold, a semi-solid mass will be formed. 

Wheat jelly and barley jelly. — Wheat jelly 
and barley jelly are made in the same way 
as oatmeal jelly, using cracked wheat or bar- 
ley grains. 

Barley-water. — Robinson's barley flour or 
Cereo Co.'s barley flour, one rounded table- 
spoonful; water, one pint; boil thirty minutes, 
strain, add water to make one pint. The 
barley should be well blended with a small 
quantity of cold water, making a paste, and 
then added to sufficient water to make one 
pint. 

Rice-water. — Rice, one tablespoon ful ; water, 
one pint; boil three hours, adding water from 
time to time, so that there is one pint of rice- 
water at the end of three hours. 

Dextrinized barley-water. — Robinson's bar- 



316 Food Formulas 

ley flour or Cereo barley flour, three table- 
spoonfuls; water, one pint; boil twenty min- 
utes, add water to make a pint. When luke- 
warm (ioo°F.) add one teaspoonful of 
Cereo, strain ; this changes the starch into dex- 
trinized maltose. 

Oatmeal-water. — Oatmeal, one tablespoon- 
f ul ; water, one pint ; cook three hours and add 
water to make one pint. The granum should 
be well blended with a small quantity of cold 
water, making a paste, and then added to suffi- 
cient water to make one pint. 

Imperial granum-water. — Imperial granum, 
one tablespoonful ; water, one pint ; cook thirty 
minutes and add water to make one pint. 

Whey. — Put one pint of fresh milk into a 
saucepan and heat it lukewarm, not over ioo° 
F. ; then add two (2) teaspoonfuls of Fair- 
child's essence of pepsin and stir just enough 
to mix. Let it stand until firmly jellied, then 
beat with a fork until it is finely divided, strain, 
and the whey, the liquid part, is ready for 
use. 

Junket. — Heat one pint of milk to ioo° F. 
Add one junket tablet previously dissolved in 
a little water or two teaspoons of essence of 
pepsin, two teaspoons of sugar, and a .few 



Prune Juice 3*7 

drops essence of vanilla. Allow to stand per- 
fectly quiet until the curd is set, when it should 
be placed on the ice. 

Cornstarch pudding. — Dissolve one table- 
spoonful of cornstarch in a little milk. Heat 
one pint of milk to nearly boiling point. Add 
cornstarch slowly, then one tablespoonful 
of sugar and stir until it thickens. When 
cool add 5 drops of flavoring. 

Soft custard. — Heat one cup of milk to boil- 
ing point. Add one yolk of egg well beaten, 
one teaspoonful of sugar and a pinch of salt. 
Cook in a double boiler, stirring until it 
thickens. Strain and add five drops of flavor- 
ing. 

PRUNE JUICE 

Take one pound of prunes, wash thoroughly, 
place in a pan, cover with cold water and allow 
to stand over night. Place on stove next morn- 
ing, bring to a boil and allow to simmer until 
very soft. Strain off the juice (which should 
be eight ounces juice) and give the required 
amount for the infant. 

For older children the pulp may be used 
with the juice after putting through a sieve. 



3i8 Coddled Egg 

CODDLED EGG 

Take a fresh egg, place it in a pan of boiling 
water, put on the back of the stove and stand 
for three minutes, having pan tightly covered. 



THE END 



1000 Things a Mother 
Should Know 

By 
Mae Savell Croy 

Author of " 1000 Shorter Ways Around the Hou«e," etc. 



Information is given regarding tiny babies 
and growing children: their clothes, their 
care, their food, their training, and their en- 
tertainment. The book embraces everything 
from the prenatal precautions to be observed 
by the prospective mother to the rearing of 
the child to a healthy adolescence. Not only 
are the bodily needs intelligently specified, but 
the character-building influences that should 
surround the child are conveyed in the excel- 
lent suggestions offered. Health rules and 
medical care, hygiene and sick-room sugges- 
tions, are a valuable supplement to the chap- 
ters dealing with the treatment of the child 
when in health. Arranged under appropriate 
headings and comprehensively indexed. 



G. P. Putnam's Sons 

New York London 



Radiant 
Motherhood 

A Book for Those Who are 
Creating the Future 

By Marie Carmichael Slopes 

Doctor of Science, London; Doctor of Philosophy, Munich; 
Fellow of University College, London; Fellow of the Royal 
Society of Literature; and the Linnean Society, London 

In "Radiant Motherhood" the joys and diffi- 
culties of young parents are treated with 
helpful perception, the glory, power and 
sacrifice of motherhood are made clear by 
dealing frankly with the physical and psy- 
chological states of the mother to-be; nor is 
the father to-be forgotten, as the author dis- 
plays her power of understanding and helping 
to remove the difficulties and distresses of the 
young husband. 

The chapters are of unique help to the mod- 
ern man and woman by separating clearly 
(1) the nature-imposed difficulties from (2) 
those entirely artificial, and (3) those which 
are to-day general, but which by knowledge 
can be completely conquered. The author 
creates round the subject the light of beauty 
and joy springing from true understanding. 

Were all mothers and fathers to know what is in 
this hooky and use its wisdom, a few decades would 
see the human race transformed and irradiated. 



G. P. Putnam's Sons 
New York London 



Ill 

022 169 358 9 



